This is a fully remote position, open to applicants in California, +2 more states.

📋 Description

• Set up and manage medical coverage policies within Cohere’s product platform.

• Perform quality assurance evaluations and testing of policy setups.

• Keep track of updates to medical coverage policies and modify them to ensure compliance.

• Act as a subject matter expert on medical coverage policies, offering guidance and support to both internal teams and customers.

• Respond to inquiries and feedback from internal and external customers regarding policy setups.

• Work collaboratively with clinical experts, product managers, engineers, medical writers, and utilization management reviewers to enhance policy implementation and usability.

⛳️ Requirements

• Minimum of 2 years of relevant experience in utilization management, medical policy development, health technology assessment, or payer policy configuration.

• Strong grasp of medical coverage policies and prior authorization requirements.

• Familiarity with healthcare data structures and clinical coding (ICD-10, HCPCS, CPT).

• Proficient in Microsoft Word, Excel, Google Drive, Confluence, and Jira.

• Exceptional attention to detail with a background in quality assurance and validation processes.

• Capability to work both independently and collaboratively within a team.

• A passion for enhancing the U.S. healthcare system and ensuring optimal patient care.

• Self-motivated, confident, and able to excel in a dynamic startup environment.

• Bachelor’s Degree in Nursing (BSN) or equivalent clinical experience.

• This position is not available for hire in CA, NY, or WA.