Clinical Integrity Manager New

Cohere Health; Northern (KY); Hybrid; USD 108,000 - 125,000; Full time

Benefits offered by this job

Fully remote

Travel 10%

Medical insurance

Dental insurance

Vision insurance

Life insurance

Disability insurance

Employee Assistance Program

401K with match

Flexible spending account

Health savings account

Paid parental leave

Job summary

Cohere Health is seeking a Manager of Clinical Integrity to lead and scale our UM programs and clinical governance. This role partners across Clinical Operations, Product, Engineering, and Legal to embed clinical integrity in the product lifecycle and client commitments.

You will translate clinical strategy into scalable processes, governance, and day-to-day operations, while supporting AI-enabled capabilities and ensuring regulatory compliance.

Qualifications

• RN with active, unrestricted license and a Bachelor’s degree in Nursing or related field.
• 5+ years of progressive Utilization Management/Clinical Operations experience, including 2+ in leadership.
• Strong knowledge of Medicare Advantage, Medicaid, Commercial/Marketplace UM, CMS regulations, and NCQA accreditation.

Responsibilities

• Perform clinical reviews to ensure alignment with evidence-based practice and regulatory requirements.
• Write and refine clinical requirements, user stories, and acceptance criteria for UM workflows and AI-enabled capabilities.
• Own operational readiness: run hands-on UAT, build test scripts, document defects, and track releases.
• Audit client commitments and SLAs against product capabilities and drive remediation.
• Build governance docs, SOPs, playbooks, and training materials for consistent clinical workflows.

Skills

RN license

Leadership

Utilization Management

Medicare/Medicaid knowledge

Clinical governance

Education

Bachelor's degree in Nursing

Job description

We are seeking a technology-savvy clinical leader with strong expertise in Utilization Management (UM) to join Cohere Health as the Manager, Clinical Integrity. Reporting to the Vice President, Clinical Integrity, this role is a hands-on operational leader responsible for directly executing and maintaining the integrity, scalability, and operational readiness of Cohere's clinical programs and technology-enabled solutions.

The Manager works alongside leaders across Clinical Operations, Product, Engineering, Clinical Programs, Client Success, Growth, Implementation, and Clinical Strategy to ensure that clinical integrity is embedded throughout the product lifecycle and operational execution. This leader directly translates enterprise clinical strategy into scalable processes, governance documentation, and day-to-day operational excellence while ensuring Cohere's clinical capabilities consistently meet regulatory requirements, client commitments, and evidence-based standards.

As a subject matter expert in utilization management, this role actively supports delegated clinical operations, participates in new client implementations, evaluates emerging clinical needs, and ensures seamless integration between clinical operations and technology. The Manager executes clinical governance activities while contributing to innovation through hands-on automation testing, workflow optimization, and responsible adoption of AI-enabled solutions.

What you’ll do:

• Perform clinical reviews of our product, workflows, and programs to ensure they align with evidence-based practice, regulatory requirements, and client expectations
• Write and refine clinical requirements, user stories, and acceptance criteria for UM workflows, clinical decision support, and AI-enabled capabilities — and represent clinical integrity directly in sprint planning and design sessions with Product and Engineering
• Own operational readiness: run hands-on UAT, build test scripts and scenarios, document defects, and track readiness status for releases and client implementations
• Audit client commitments and SLAs against current product capabilities, flag gaps, and drive remediation
• Build and maintain governance documentation, SOPs, playbooks, and training materials that keep clinical workflows consistent across all lines of business
• Partner cross-functionally with Clinical Operations, Product, Engineering, Client Success, Compliance, Legal, and Clinical Strategy as the day-to-day point of contact for clinical integrity
• Support business growth by contributing clinical assessments, RFP/RFI responses, and feasibility reviews for prospective clients

What you’ll need:

• An RN, PT, OT, or SLP with an active, unrestricted clinical license and a Bachelor's degree in Nursing, Therapy, Healthcare Administration, or a related field
• 5+ years of progressive experience in Utilization Management, Clinical Operations, or health plan operations, including 2+ years in a leadership or supervisory capacity
• Strong knowledge of Medicare Advantage, Medicaid, Commercial, and Marketplace UM, along with CMS regulations, NCQA accreditation, and delegation oversight
• Experienced partnering with Product and Technology teams to shape clinical workflows and digital solutions — you've influenced what gets built, not just used what was handed to you
• Comfortable with hands-on execution: writing documentation, testing workflows, building process tools, and managing the details
• A strong communicator who can build trust and influence stakeholders across functions without formal authority
• Bonus points for a Master's degree, experience with AI-enabled clinical workflows, familiarity with InterQual® or MCG®, a Lean/Six Sigma/Agile/PM certification, or prior UAT/QA experience in a tech environment

• 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 $108,000 to $125,000 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.