Enable job alerts via email!

Associate Medical Director, Utilization Management

Leading Age

Boston (MA)

Remote

USD 200,000 - 270,000

Full time

30+ days ago

Boost your interview chances

Create a job specific, tailored resume for higher success rate.

Job summary

Join a fast-growing clinical intelligence company that is transforming patient care through innovative solutions. In this dynamic role, you will leverage your expertise in Internal Medicine to assess medical appropriateness and enhance patient outcomes. Collaborating with a dedicated team, you will review clinical information and apply evidence-based guidelines to ensure the highest quality of care. This position offers the chance to make a significant impact in a supportive and inclusive environment, where your contributions are valued, and professional growth is encouraged. If you are passionate about improving healthcare and thrive in a fast-paced setting, this opportunity is for you.

Benefits

Health Insurance
401k
Bonus
Flexible Work Hours
Professional Development Opportunities

Qualifications

  • 5+ years of clinical practice in Internal Medicine required.
  • Must have board certification and a current unrestricted state license.

Responsibilities

  • Review clinical decision guidelines and provide expert input.
  • Conduct peer-to-peer discussions with treating providers.

Skills

Internal Medicine Expertise
Clinical Decision Making
Evidence-Based Guidelines
Communication Skills
Technology Proficiency

Education

Completed US-based residency program
Fellowship in Internal Medicine
Board certification as MD or DO

Tools

Clinical Workflow Tools
Medical Necessity Documentation Templates

Job description

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 cutting-edge AI combined with deep clinical expertise. In only four years our solutions have been adopted by health plans covering over 15 million lives, 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 LinkedIn Startup; TripleTree iAward; multiple KLAS Research Points of Light awards, along with recognition on Fierce Healthcare's Fierce 15 and CB Insights' Digital Health 150 lists.

Opportunity Overview:

We are looking for physicians who have expertise in Internal Medicine including medical and surgical clinical areas to deliver on Cohere’s program by determining the medical appropriateness of services by reviewing clinical information and applying evidence-based guidelines.

Reporting to the Medical Director for Cohere Health, this is a critical role in a company that is rapidly scaling to impact millions of patients. This is a fast-paced environment that favors people who are able to learn quickly, be hands-on, handle ambiguity, and communicate effectively with people of different backgrounds and perspectives.

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 you will do:

  • Support the clinical content team in reviewing the company’s clinical decision guidelines and evidence based literature
  • Provide expert input on content for influencing physicians in medical care to improve the quality of patient outcomes
  • Provide timely medical reviews that meet Cohere’s stringent quality and timeliness parameters
  • Provide clinical determinations based on evidence-based criteria while utilizing clinical acumen and knowledge of evidence based literature and medical society guidelines
  • Clearly and accurately document all communication and decision-making in Cohere workflow tools, ensuring a member and provider can easily reference and understand your decision
  • Use correct templates for documenting medical necessity decisions during case review
  • Conduct timely peer-to-peer discussions with treating providers to clarify clinical information and to explain review outcome decisions, including feedback on alternate treatment based on medical necessity criteria and evidence-based research
  • Demonstrate the highest level of professionalism, accountability, and service in your 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

Your background & requirements:

Required:

  • Completed US-based residency program and fellowship in Internal Medicine
  • Board certification as an MD or DO with a current unrestricted state license to practice medicine - reviewers must maintain necessary credentials to retain the position
  • 5+ years of clinical practice beyond residency/fellowship in Internal Medicine
  • Excels in a matrix organization
  • Comfortable with technology - willing and able to learn new software tools
  • Understanding of managed care regulatory structure and processes
  • Consultant agrees to cooperate fully with Cohere by obtaining state licenses or registrations when requested by Cohere

Preferred:

  • 2+ years of managed care utilization review experience desirable
  • Membership in national and/or regional specialty societies

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 $200,000 to $270,000 annually, based on years of utilization management experience; 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.

#LI-Remote

#BI-Remote

Get your free, confidential resume review.
or drag and drop a PDF, DOC, DOCX, ODT, or PAGES file up to 5MB.

Similar jobs

Physician / Gastroenterology / Texas / Permanent / Associate Medical Director - Gastro - 100% R[...]

eviCore healthcare

Texas

Remote

USD 150,000 - 250,000

10 days ago

Associate Medical Director (Remote)

Lifeforce

Santa Monica

Remote

USD 225,000 - 250,000

3 days ago
Be an early applicant

Physician / Gastroenterology / Illinois / Permanent / Associate Medical Director - Gastro - 100[...]

eviCore healthcare

Illinois

Remote

USD 200,000 - 300,000

3 days ago
Be an early applicant

Physician / Oncology / Arizona / Permanent / Associate Medical Director - Oncology - 100% Remot[...]

eviCore healthcare

Phoenix

Remote

USD 200,000 - 300,000

3 days ago
Be an early applicant

Physician / Neurology / Texas / Permanent / Associate Medical Director - Neurology - 100% Remot[...]

eviCore healthcare

Brownsville

Remote

USD 150,000 - 210,000

3 days ago
Be an early applicant

Physician / Gastroenterology / Texas / Permanent / Associate Medical Director - Gastro - 100% R[...]

eviCore healthcare

Brownsville

Remote

USD 180,000 - 220,000

3 days ago
Be an early applicant

Physician / Cardiology / Florida / Permanent / Associate Medical Director - Cardiology - 100% R[...]

eviCore healthcare

Jacksonville

Remote

USD 150,000 - 220,000

3 days ago
Be an early applicant

Physician / Surgery - Orthopedics / Texas / Permanent / Associate Medical Director - Orthopedic[...]

eviCore healthcare

Houston

Remote

USD 200,000 - 300,000

4 days ago
Be an early applicant

Physician / Oncology / Texas / Permanent / Associate Medical Director - Oncology - 100% Remote [...]

eviCore healthcare

Houston

Remote

USD 150,000 - 210,000

4 days ago
Be an early applicant