Clinical Training & Quality Specialist

United Statesfull timeRemote

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entry

$70k–$78k

H1B: yes

Cohere Health Clinical Training & Quality Specialist at Cohere Health implements clinical quality measurements and supports training and quality needs of Clinical Operations. The role involves auditing clinical decisions, developing coaching sessions, and managing quality improvement projects.

Responsibilities

Audit Individual Operations team members on Clinical decisions against clinical guidelines
Translate QA findings into clear insights and recommendations for operational leaders and cross-functional partners.
Develop and deploy structured coaching sessions based on audit findings to improve accuracy, decision-making, and skill development.
Create and ensure accuracy of SOPs, job aids, workflow guides, and new product readiness materials.
Facilitate onboarding and ongoing upskilling sessions for Clinical teams using adult learning principles and SME feedback.
Lead QA/Training side of project implementations by operationalizing workflow changes, quality expectations, and training updates into the business.
Partner with Product, Clinical, Client Services, and Operations to validate workflow changes and identify potential quality or compliance risks.
Support change management by communicating process updates and aligning QA expectations across impacted teams.
Serve as a subject matter expert and advisor to frontline leaders on quality trends, training needs, and operational readiness.
Manage multiple concurrent priorities with independence, ownership, and accountability for deliverables, exercise discretion and independent judgment.
Step into operational queues to maintain service levels and ensure continuity of operations, as needed during high-volume periods.
Coach team members for improvement against quality metrics

Qualification

Active RN LicensureAttention to detailData collectionProblem analysis and problem solving

Required

Active RN Licensure
2+ years experience in the process of Coverage Determinations in Healthcare
NCQA and CMS standards for Utilization Management Authorization decisions
LCD/NCD Coverage Determination Ability to conduct effective coaching sessions
Understanding of Adult Learning Theory and Training RN
Attention to detail, Communication skills - verbal and written
Data collection, management and analysis
Problem analysis and problem solving, Planning and organizing, Effective interaction with stakeholders
Experience in the process of Coverage Determinations in Healthcare
Proficiency with Google Workspace (Sheets, Docs, Forms); ability to build pivot tables and create charts or dashboards is a plus
Experience identifying performance trends and root causes through data is a plus
Experience using quality management systems and conducting structured QA audits is a plus