Clinical Reviewer, Physician Assistant

Skills

About the Role

You'll join Cohere Health's musculoskeletal and orthopedic review team as an orthopedic spine Physician Assistant, helping determine the medical appropriateness of services by reviewing clinical information and applying evidence-based guidelines. Drawing on your experience managing spine conditions in an office setting and assisting on spine cases in the operating room, you'll provide timely, high-quality medical reviews and clinical determinations. You'll report to the Managing Medical Director of MSK Spine and Ortho and work alongside intake specialists, nurses, and physicians in a fast-paced, rapidly scaling environment. Training and supervision will be provided, and while this is a remote-first role, you may occasionally travel to Boston, MA for onboarding and team events.

Requirements

• Graduate of an accredited Physician Assistant program
• Current NCCPA certification (PA-C) and active, unrestricted Physician Assistant license in at least one U.S. state
• 3+ years of clinical experience supporting orthopedic spine surgeons and/or neurosurgeons treating spine conditions
• Utilization management, prior authorization, or medical review experience a plus
• Membership in organizations such as the AAPA or specialty spine organizations

Responsibilities

• Provide timely medical reviews that meet Cohere's stringent quality parameters
• Provide clinical determinations based on evidence-based criteria while utilizing clinical acumen
• Clearly and accurately document all communication and decision-making in Cohere workflow tools
• Use correct templates for documenting decisions during case review
• Meet the appropriate turn-around times for clinical reviews
• Demonstrate the highest level of professionalism, accountability, and service in 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
• Clearly communicate with team members

Benefits

• Fully remote opportunity with about 5% 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
• Pet insurance