Clinical Policy Configuration Specialist
Healthcare AI company automating prior authorization and utilization management.
Boston, Massachusetts, USA
About Cohere Health
Cohere Health (coherehealth.com) is a Boston healthcare technology company whose AI-driven platform automates prior authorization and care coordination for health plans.
Skills
Candidate Availability
Required and preferred rules are kept separate and reflect the wording in the original posting.
About the Role
You will configure and maintain medical coverage policies in the product platform, perform quality assurance and testing, monitor policy updates, and ensure compliance and clinical appropriateness. You will advise internal teams and customers on policy configuration, address inquiries and feedback, and collaborate with clinical, product, engineering, writing, and utilization management teams.
Requirements
- 2+ years of experience in utilization management, medical policy development, health technology assessment, or payer policy configuration
- Understanding of medical coverage policies and prior authorization criteria
- Familiarity with healthcare data structures
- Clinical coding knowledge including ICD-10, HCPCS, and CPT
- Knowledge of Microsoft Word, Excel, Google Drive, Confluence, and Jira
- Quality assurance and validation experience
- Bachelor’s degree in Nursing or equivalent clinical background
Responsibilities
- Configure and maintain medical coverage policies
- Conduct quality assurance reviews and testing
- Monitor medical coverage policy updates
- Provide guidance on policy configurations
- Address customer inquiries and feedback
- Collaborate with clinical, product, engineering, medical writing, and utilization management teams
- Optimize policy implementation and usability
Benefits
- Fully remote work
- Medical insurance
- Dental insurance
- Vision insurance
- Life insurance
- Disability insurance
- Employee Assistance Program
- 401K retirement plan with company match
- Flexible spending account
- Health savings account
- Flex Time Off
- Company holidays
- Up to 14 weeks of paid parental leave
- Pet insurance