Clinical Integrity Director

Cohere Health; Boston (MA); Remote; USD 159,000 - 180,000; Full time

Job summary

Cohere Health is seeking a Clinical Integrity Director, a remote-first leader reporting to the VP of Clinical Integrity. You will own governance, readiness, and end-to-end integrity of clinical programs and technology-enabled solutions across Clinical Operations, Product, Engineering, Client Success, and Compliance.

You will drive multi-workstream accountability, translate regulatory changes into product specs, and ensure timely go-live readiness for client implementations, with occasional

Qualifications

• Active unrestricted clinical license (RN/PT/OT/SLP) and a bachelor's in a clinical field.
• 7+ years in UM/Clinical Ops/Health Plan ops, incl. 3+ years leading programs or teams.
• Strong knowledge of Medicare Advantage, Medicaid, commercial plans, and CMS regs.
• Experience managing multiple workstreams with Product, Engineering, Ops in tech-enabled env.

Responsibilities

• Own and manage clinical integrity governance programs with dashboards.
• Lead clinical impact assessment for policy changes and product updates.
• Manage clinical requirements pipeline to Product and Engineering.
• Translate regulatory and clinical changes into product specs with timelines.
• Oversee operational readiness for product releases and client implementations.
• Lead clinical UAT, assign testing, triage defects, ensure resolution before go-live.
• Develop readiness scorecards for go/no-go visibility.
• Serve as operational point of contact across teams.
• Prepare clinical integrity materials for RFPs, RFIs, questionnaires.
• Lead readiness for new client implementations and feasibility assessments.

Skills

Utilization Management

Clinical Operations

Program management

Cross-functional collaboration

Regulatory knowledge

Education

Bachelor's degree in Nursing, Therapy, Healthcare Administration, or related clinical discipline

Master's degree in Healthcare Administration or MBA

Tools

InterQual/MCG

AI-enabled clinical workflows

Job description

We are seeking a technology-savvy clinical leader with strong Utilization Management (UM) expertise to join Cohere Health as the Clinical Integrity Director. Reporting to the Vice President of Clinical Integrity, this role is a program-level operational leader responsible for managing the day-to-day integrity, governance, and readiness of Cohere's clinical programs and technology-enabled solutions.

While the Vice President sets enterprise strategy and provides executive-level clinical oversight, the Director owns the operational programs that bring that strategy to life. This leader manages clinical integrity workstreams end-to-end — from governance documentation and product testing to implementation readiness and cross-functional coordination — ensuring nothing falls through the cracks as Cohere scales.

The Director works across Clinical Operations, Product, Engineering, Client Success, and Compliance to ensure clinical integrity is operationalized consistently. This role requires someone who can manage multiple concurrent workstreams, drive accountability across teams, and step in hands-on when needed.

This is a remote-first role that may require travel to Boston, MA for new hire onboarding and occasional in-person team meetings and company events.

What you’ll do:

• Own and manage clinical integrity governance programs, including reviews, documentation, tracking, frameworks, checklists, and dashboards across all active programs
• Manage the clinical impact assessment process for policy changes, product updates, and regulatory shifts — escalating findings to the VP as needed
• Own the clinical requirements pipeline by managing intake, prioritization, and delivery of clinical requirements to Product and Engineering teams
• Manage the end-to-end process for translating regulatory and clinical changes into product specifications, ensuring timelines and dependencies are tracked
• Own the operational readiness program for product releases and client implementations, including timelines, milestones, and cross-functional accountability
• Manage the clinical UAT process: assign testing, review results, triage defects, and ensure resolution before go-live
• Develop and maintain readiness scorecards providing leadership with clear go/no-go visibility for each release or implementation
• Serve as a primary operational point of contact for Clinical Integrity across Product, Engineering, Clinical Operations, Compliance, and Client Success
• Manage preparation of clinical integrity materials for RFPs, RFIs, and client questionnaires
• Lead clinical readiness activities for new client implementations and conduct feasibility assessments for prospective client requirements

What you’ll need:

• Active unrestricted clinical license (RN, PT, OT, or SLP) and a Bachelor's degree in Nursing, Therapy, Healthcare Administration, or related clinical discipline
• 7+ years of progressive experience in Utilization Management, Clinical Operations, or Health Plan operations, including 3+ years managing programs, projects, or teams
• Strong knowledge of Medicare Advantage, Medicaid, Commercial, and Marketplace utilization management, as well as CMS regulations, NCQA accreditation standards, and state regulatory requirements
• Demonstrated experience managing multiple concurrent workstreams and cross-functional projects involving Product, Engineering, and Operations teams in a fast-paced, technology-enabled environment
• Proven ability to drive accountability, manage timelines, and deliver results through others with strong organizational, communication, and problem-solving skills
• Master's degree in Healthcare Administration or Business Administration, Lean/Six Sigma/Agile/PMP certification, and experience with clinical UAT programs, InterQual/MCG, or AI-enabled clinical workflows are a plus

Fully remote opportunity with about 10% travel

Medical, dental, vision, life, disability insurance, and Employee Assistance Program

401K retirement plan with company match; flexible spending and health savings account

Up to 14 weeks of paid parental leave

The salary range for this position is $159,000 to $180,000 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.

Interview Process*:

• Connect with Talent Acquisition for a Preliminary Phone Screening
• Meet your Hiring Manager!
• Behavioral Interview(s)

*Subject to change

About Cohere Health:

Cohere Health’s clinical intelligence platform and agentic AI-powered solutions connect health plans’ strategic goals and providers’ needs, optimizing the speed, cost, and quality of care. With an enterprise approach that streamlines payer-provider decision-making across the care continuum–including policy, prior authorization, payment accuracy, and more–the company improves collaboration and reduces burden, resulting in up to 8x ROI and 94% provider satisfaction.

With the acquisition of ZignaAI, we’ve further enhanced our platform by launching our Payment Integrity Suite, anchored by Cohere Validate, an AI-driven clinical and coding validation solution that operates in near real-time. By unifying pre-service authorization data with post-service claims validation, we’re creating a transparent healthcare ecosystem that reduces waste, improves payer‑provider collaboration and patient outcomes, and ensures providers are paid promptly and accurately.

Cohere Health’s innovations continue to receive industry wide recognition. We’ve been named to the 2025 Inc. 5000 list and in the Gartner Hype Cycle for U.S. Healthcare Payers (2022-2025), and ranked as a Top 5 LinkedIn Startup for 2023 & 2024. Backed by leading investors such as Deerfield Management, Define Ventures, Flare Capital Partners, Longitude Capital, and Polaris Partners.

The Coherenauts, as we call ourselves, 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.

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.

Voluntary Self-Identification

For government reporting purposes, we ask candidates to respond to the below self-identification survey.Completion of the form is entirely voluntary. Whatever your decision, it will not be considered in the hiringprocess or thereafter. Any information that you do provide will be recorded and maintained in aconfidential file.

As set forth in Cohere Health’s Equal Employment Opportunity policy,we do not discriminate on the basis of any protected group status under any applicable law.

If you believe you belong to any of the categories of protected veterans listed below, please indicate by making the appropriate selection.As a government contractor subject to the Vietnam Era Veterans Readjustment Assistance Act (VEVRAA), we request this information in order to measurethe effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA. Classification of protected categoriesis as follows:

A "disabled veteran" is one of the following: a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or a person who was discharged or released from active duty because of a service-connected disability.

A "recently separated veteran" means any veteran during the three-year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval, or air service.

An "active duty wartime or campaign badge veteran" means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.

An "Armed forces service medal veteran" means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.