Clinical Policy Configuration Specialist

Cohere Health; United States; Remote; USD 65,000 - 80,000; Full time

Benefits offered by this job

Fully remote work

Medical, dental, vision, life, & E

Employee Assistance Program

401K with company match

Flexible spending & Health Savings

Parental leave (up to 14 weeks)

Job summary

Cohere Health is seeking a Clinical Policy Configuration Specialist to join our Clinical Operations team. You will configure and maintain medical coverage policies within our platform, collaborating with clinical experts, product, engineering, and operations to ensure compliant, evidence-based policy implementation.

The role supports scalable, high-quality clinical decision-making. You’ll work on policy configuration, QA validation, and staying current with policy updates, while helping

Qualifications

• 2+ years in utilization management, medical policy development, health tech assessment, or payer policy configuration.
• Strong understanding of medical coverage policies and prior authorization criteria.
• Familiarity with ICD-10, HCPCS, CPT coding.
• Proficient with Word, Excel, Google Drive, Confluence, Jira.
• Strong attention to detail with QA/validation experience.
• Ability to work independently and as part of a team.

Responsibilities

• Configure and maintain medical coverage policies within Cohere’s product platform to ensure accuracy, consistency, and compliance with industry standards.
• Conduct quality assurance reviews and testing of policy configurations to validate functionality and clinical appropriateness.
• Monitor updates on medical coverage policies to adjust policies and maintain compliance.
• Serve as a subject matter expert on medical coverage policies, providing guidance and support to internal teams and customers.
• Address inquiries and feedback regarding policy configurations, ensuring alignment with payers, providers, and reviewers.
• Collaborate with clinical experts, product managers, engineers, medical writers, and reviewers to optimize policy implementation and usability.

Skills

Utilization management

Medical policy development

Health technology assessment

Payer policy configuration

Attention to detail

Team collaboration

Education

Bachelor’s Degree in Nursing (BSN) or equivalent

Tools

Microsoft Word

Microsoft Excel

Google Drive

Confluence

Jira

Job description

Opportunity Overview

We are seeking a Clinical Policy Configuration Specialist to join our Clinical Operations team. In this role, you will ensure medical coverage policies are accurately configured, maintained, and compliant within Cohere's platform, directly supporting high-quality, consistent clinical decision-making. You'll partner closely with clinical experts, product, engineering, and operations teams to optimize policy implementation - making this an opportunity to shape how evidence-based care is delivered at scale.

What you’ll do

• Configure and maintain medical coverage policies within Cohere’s product platform to ensure accuracy, consistency, and compliance with industry standards.
• Conduct quality assurance reviews and testing of policy configurations to validate functionality and clinical appropriateness.
• Monitor updates on medical coverage policies to adjust policies and maintain compliance.
• Serve as a subject matter expert on medical coverage policies, providing guidance and support to internal teams and customers.
• Address internal/external customer inquiries and feedback regarding policy configurations, ensuring alignment with payers, providers, and reviewers.
• Collaborate cross-functionally with clinical experts, product managers, engineers, medical writers, and utilization management reviewers to optimize policy implementation and usability.

What you’ll need

• 2+years of related experience working in utilization management, medical policy development, health technology assessment, or payer policy configuration.
• Strong understanding of medical coverage policies and prior authorization criteria.
• Familiarity with healthcare data structures, and clinical coding (ICD-10, HCPCS, CPT).
• Must be knowledgeable of multiple software programs (Microsoft Word, Excel, Google Drive, Confluence, Jira)
• Strong attention to detail with experience in quality assurance and validation processes.
• Ability to work independently and as part of a team
• You are passionate about improving the U.S. healthcare system and helping ensure every patient receives the best care possible
• You are self-directed, confident, and thrive working in a fast-paced startup environment
• Bachelor’s Degree in Nursing (BSN) or equivalent clinical background

Pay & Perks

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

The salary range for this position is $65,000 to $80,000 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. This role is not eligible for hire in: CA, NY, or WA.

Interview Process

1. Connect with Talent Acquisition for a Preliminary Phone Screening
2. Meet your Hiring Manager!
3. Team Interview
4. Cross Functional Interview

*Subject to change

About Cohere Health

Cohere'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'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, Cohere Health drives more transparent, streamlined healthcare processes, helping patients receive faster, more appropriate care and higher-quality outcomes.

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.