Clinical Integrity Manager

United Statesfull timeRemote

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mid

$108k–$125k

H1B: yes

Cohere Health Clinical Integrity Manager at Cohere Health responsible for executing and maintaining the integrity and scalability of clinical programs and technology-enabled solutions. Lead clinical governance and operational readiness activities.

Responsibilities

Perform clinical reviews of our product, workflows, and programs to ensure they align with evidence-based practice, regulatory requirements, and client expectations
Write and refine clinical requirements, user stories, and acceptance criteria for UM workflows, clinical decision support, and AI-enabled capabilities — and represent clinical integrity directly in sprint planning and design sessions with Product and Engineering
Own operational readiness: run hands-on UAT, build test scripts and scenarios, document defects, and track readiness status for releases and client implementations
Audit client commitments and SLAs against current product capabilities, flag gaps, and drive remediation
Build and maintain governance documentation, SOPs, playbooks, and training materials that keep clinical workflows consistent across all lines of business
Partner cross-functionally with Clinical Operations, Product, Engineering, Client Success, Compliance, Legal, and Clinical Strategy as the day-to-day point of contact for clinical integrity
Support business growth by contributing clinical assessments, RFP/RFI responses, and feasibility reviews for prospective clients

Qualification

An RNStrong knowledge of Medicare AdvantageComfortable with hands-on executionBonus points for a Master's degree🩺 Medical🏝️ Flex Time Off + company holidays

Required

An RN, PT, OT, or SLP with an active, unrestricted clinical license and a Bachelor's degree in Nursing, Therapy, Healthcare Administration, or a related field
5+ years of progressive experience in Utilization Management, Clinical Operations, or health plan operations, including 2+ years in a leadership or supervisory capacity
Strong knowledge of Medicare Advantage, Medicaid, Commercial, and Marketplace UM, along with CMS regulations, NCQA accreditation, and delegation oversight
Experienced partnering with Product and Technology teams to shape clinical workflows and digital solutions — you've influenced what gets built, not just used what was handed to you
Comfortable with hands-on execution: writing documentation, testing workflows, building process tools, and managing the details
A strong communicator who can build trust and influence stakeholders across functions without formal authority
Bonus points for a Master's degree, experience with AI-enabled clinical workflows, familiarity with InterQual® or MCG®, a Lean/Six Sigma/Agile/PM certification, or prior UAT/QA experience in a tech environment
💻 Fully remote opportunity with about 10% travel
🩺 Medical, dental, vision, life, disability insurance, and Employee Assistance Program
📈 401K retirement plan with company match; flexible spending and health savings account
🏝️ Flex Time Off + company holidays
👶 Up to 14 weeks of paid parental leave

Benefits

Medical
Dental
Vision
401(k)
Parental Leave
Life Insurance
Wellness

Company

Cohere Health

View company page

Source: greenhouse

Active within the past hour

Remote-friendly

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Clinical Integrity Manager at Cohere Health · LumiJobs