Clinical Training & Quality Specialist New

Cohere Health; Northern (KY); Hybrid; USD 70,000 - 78,000; Full time

Benefits offered by this job

Health insurance

401k with company match

Paid parental leave

Job summary

Cohere Health is seeking a Clinical Quality and Training Specialist to join the Training and Quality team. You will implement clinical quality measurements, scoring, and performance improvement data designed to improve efficiency while exceeding industry standards for quality and clinical guidance.

You will guide and support training needs, developing clinical training and development initiatives. Fully remote opportunity with about 5% travel.

Qualifications

• Active RN licensure required.
• 2+ years experience with Coverage Determinations in healthcare.
• Familiarity with NCQA and CMS Utilization Management standards.
• Experience using quality management systems and conducting QA audits.

Responsibilities

• Audit Operations team members on clinical decisions against guidelines.
• Translate QA findings into insights for leaders and partners.
• Develop and deploy structured coaching sessions based on audit findings.
• Create SOPs, job aids, workflow guides, and product readiness materials.
• Facilitate onboarding and upskilling for Clinical teams using adult learning principles.
• Lead QA/Training during project implementations and drive quality improvements.
• Collaborate with Product, Clinical, Client Services, and Operations to validate workflow changes.
• Support change management by communicating process updates and QA expectations.
• Serve as SME adviser to frontline leaders on quality trends and readiness.
• Manage multiple priorities with independence and accountability.
• Step into operational queues to maintain service levels during high volumes.
• Coach team members for improvement against quality metrics; report to Sr Leadership.

Skills

RN licensure

Coverage determinations

QA audits

Adult learning theory

Tools

Google Workspace

Job description

We are seeking a Clinical Quality and Training Specialist to join our Training and Quality team. In this role, you will implement clinical quality measurements, scoring, and performance improvement data designed to improve operational efficiency while exceeding industry standards for quality performance and clinical guidance. You will apply subject-matter expertise to guide and support the training and quality needs of Clinical Operations. This includes building the success of the company through clinical training and development. With a solid foundation in quality analysis, feedback, instructing/coaching; you are expected to be flexible and nimble in your role to manage short- and long-term projects as well as dealing with day-to-day QA tasks. Cohere culture is one of partnership and ownership.

What you’ll do:

• Audit Individual Operations team members on Clinical decisions against clinical guidelines
• Translate QA findings into clear insights and recommendations for operational leaders and cross-functional partners.
• Develop and deploy structured coaching sessions based on audit findings to improve accuracy, decision-making, and skill development.
• Create and ensure accuracy of SOPs, job aids, workflow guides, and new product readiness materials.
• Facilitate onboarding and ongoing upskilling sessions for Clinical teams using adult learning principles and SME feedback.
• Lead QA/Training side of project implementations by operationalizing workflow changes, quality expectations, and training updates into the business.
• Partner with Product, Clinical, Client Services, and Operations to validate workflow changes and identify potential quality or compliance risks.
• Support change management by communicating process updates and aligning QA expectations across impacted teams.
• Serve as a subject matter expert and advisor to frontline leaders on quality trends, training needs, and operational readiness.
• Manage multiple concurrent priorities with independence, ownership, and accountability for deliverables, exercise discretion and independent judgment.
• Step into operational queues to maintain service levels and ensure continuity of operations, as needed during high-volume periods.
• Coach team members for improvement against quality metrics
• Provide reporting on performance and key areas of quality improvement to Sr Leadership
• Other duties as assigned

What you’ll need:

• Active RN Licensure
• 2+ years experience in the process of Coverage Determinations in Healthcare
• NCQA and CMS standards for Utilization Management Authorization decisions
• LCD/NCD Coverage DeterminationAbility to conduct effective coaching sessions
• Understanding of Adult Learning Theory and Training RN
• Attention to detail, Communication skills - verbal and written
• Data collection, management and analysis
• Problem analysis and problem solving,Planning and organizing,Effective interaction with stakeholders
• Experience in the process of Coverage Determinations in Healthcare
• Proficiency with Google Workspace (Sheets, Docs, Forms); ability to build pivot tables and create charts or dashboards is a plus
• Experience identifying performance trends and root causes through data is a plus
• Experience using quality management systems and conducting structured QA audits is a plus
• Experience facilitating coaching sessions and giving constructive feedback is a ples
• Understanding of Adult Learning Theory and Training is a plus

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

Up to 14 weeks of paid parental leave

The salary range for this position is $70,000 to $78,000 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, WA.

Interview Process*:

• Connect with Talent Acquisition for a Preliminary Phone Screening
• Leadership Interview
• Cross Functional Interview

*Subject to change

About Cohere Health:

Cohere Health’s clinical intelligence platform delivers AI-powered solutions that streamline access to quality care by improving payer-provider collaboration, cost containment, and healthcare economics. Cohere Health works with over 660,000 providers and handles over 12 million prior authorization requests annually. Its responsible AI auto-approves up to 90% of requests for millions of health plan members.

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, 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.