Medical Director Therapy

Remotefull timeRemote

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senior

$210k–$260k

H1B: yes

Cohere Health Medical Director Therapy to review clinical information and determine medical appropriateness of therapy services. Provides expert input on clinical decision guidelines and conducts peer-to-peer discussions with providers.

Responsibilities

Support the clinical content team in reviewing the company’s clinical decision guidelines and evidence based literature
Provide expert input on content for influencing physicians in medical care to improve the quality of patient outcomes
Provide timely medical reviews that meet Cohere’s stringent quality and timeliness parameters
Provide clinical determinations based on evidence-based criteria while utilizing clinical acumen and knowledge of evidence based literature and medical society guidelines
Clearly and accurately document all communication and decision-making in Cohere workflow tools, ensuring a member and provider can easily reference and understand your decision
Use correct templates for documenting medical necessity decisions during case review
Conduct timely peer-to-peer discussions with treating providers to clarify clinical information and to explain review outcome decisions, including feedback on alternate treatment based on medical necessity criteria and evidence-based research
Demonstrate the highest level of professionalism, accountability, and service in your interactions with Cohere teammates and providers
Support projects specific to building the team's clinical expertise and efficiency, as delegated
Support the team on operational improvements and member/provider experience involving clinical review tasks, as delegated

Qualification

Excels in a matrix organizationDetail-orientedLicensure in AR🩺 Medical

Required

Completed US-based residency program in PM&R, Family Practice, Pediatrics, or Internal Medicine
Board certification as an MD or DO with a current unrestricted state license to practice medicine - reviewers must maintain necessary credentials to retain the position
5+ years of clinical practice beyond residency/fellowship in above specialties
Understanding of Therapy programs (PT / OT / SLP) on outpatient and inpatient basis
Excels in a matrix organization
Comfortable with technology - willing and able to learn new software tools
Understanding of managed care regulatory structure and processes
Detail-oriented, flexible, and able to work autonomously with little supervision
1+ years of managed care utilization review experience in Therapy (PT/OT/SLP) highly desirable
Licensure in AR, MO, MN, NC, IN, TX, NE is highly desirable - you should be willing to obtain additional state licenses with Cohere's support
💻 Fully remote opportunity with about 5% travel
🩺 Medical, dental, vision, life, disability insurance, and Employee Assistance Program