Manager, Clinical Operations

4 weeks ago

Greater Boston Area, United States Cohere Health Full time

Company Overview

Cohere Health is a fast-growing clinical intelligence company that's improving lives at scale by promoting the best patient-specific care options, using leading edge AI combined with deep clinical expertise. In only four years our solutions have been adopted by health insurance plans covering over 15 million people, while our revenues and company size have quadrupled. That growth combined with capital raises totaling $106M positions us extremely well for continued success. Our awards include: 2023 and 2024 BuiltIn Best Place to Work, Top 5 LinkedInTM Startup, TripleTree iAward, multiple KLAS Research Points of Light, along with recognition on Fierce Healthcare's Fierce 15 and CB Insights' Digital Health 150 lists.

Opportunity overview

Cohere's Clinical Operations team is responsible for ensuring that our healthcare partners are supported throughout their lifecycle of using the platform. The Manager, Clinical Operations position is a crucial role in our organization. In this role, you are responsible for coaching, mentoring, evaluating and developing the Reviewer team leadership and front line staff. The Manager will use established operational tools to ensure all Nurse staff and leaders are meeting or exceeding performance metrics and quality standards established by the leadership team.

As a Manager, you will work closely with the leadership team at Cohere and report to the Sr. Director/Director, Clinical Operations. You will be responsible for providing daily operational guidance to the leadership and Nurse Reviewers to allow them to meet or exceed operational objectives and metrics. You will leverage both your creative skills and communication skills to promote a high performing clinical team.

The Manager, Clinical Operations will be highly organized in order to plan daily operational activities and provide oversight of the Nurse Review teams. You will be responsible to work with the Sr. Director and leadership to develop the team's future strategy to meet the organization's goals. You will use your professionalism, personality, and communication skills to inspire the team to meet or exceed all performance standards. At a growing organization, this is a position that offers the ability to make a substantive mark on the company and its partners with exponential growth opportunities.

Last but not least: People who succeed here are empathetic teammates who are candid, kind, caring, and embody our core values and principles. We believe that diverse, inclusive teams make the most impactful work. Cohere is deeply invested in ensuring that we have a supportive, growth-oriented environment that works for everyone.

What will you do

  • Oversee the Prior Auth Nurse Reviewers, Concurrent Review Nurses or Appeals Specialists teams
  • Work closely with the leadership team to mentor and develop
  • Establish a plan for the day and communicate to all staff daily
  • Manage the daily timeliness report and ensure all cases meet expected turnaround times
  • Monitor the nurse productivity reports daily and provide feedback to the nurses, managing performance to ensure consistency
  • Lead weekly team meetings
  • Capture process efficiency ideas from the team and work with the appropriate stakeholders to recommend and lead changes needed to improve nurse efficiency.
  • Meet individually with all direct reports on bi-weekly cadence to develop solid work relationships with each team member and to share any performance feedback, positive and constructive.
  • Assists with recruiting, interviewing, and training of employees; identifies educational opportunities and knowledge gaps and constructs performance improvement plans as neededDevelops and maintains strong working relationships with other leaders and provides cross coverage as needed
  • Working with the Supervisors, track hourly nurse productivity, keeping the Director informed on productivity results as needed.
  • Advises key management on process and system enhancement opportunities
  • Exemplifies the core values of Cohere Health
  • May be asked to help with other projects as needed

Your background & responsibilities

  • Registered Nurse with an active and unencumbered license to practice
  • 2-3 years of supervisory/management experience
  • Knowledge of NCQA/CMS requirements
  • Experience using MCG, CMS NCDs/LCDs
  • 3+ years Prior Authorization, Utilization Management and/or Appeals experience required
  • Excellent computer skills and familiarity with a Mac.
  • Experience supervising and training in a remote work environment.

We can't wait to learn more about you and meet you at Cohere Health

Equal Opportunity Statement

Cohere Health is an Equal Opportunity Employer. We are committed to fostering an environment of mutual respect where equal employment opportunities are available to all. To us, it's personal.

The salary range for this position is $80,000 to $105,000 annually; as part of a total benefits package which includes health insurance, 401k and bonus. In accordance with state applicable laws, Cohere is required to provide a reasonable estimate of the compensation range for this role. Individual pay decisions are ultimately based on a number of factors, including but not limited to qualifications for the role, experience level, skillset, and internal alignment.

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