Manager, Clinical Escalations

coherehealth; United States; Remote; USD 116,000 - 125,000; Full time

Benefits offered by this job

Fully remote work

Travel up to 10%

Health insurance

401(k) with company match

Paid parental leave

Flexible time off

Employee assistance program

Pet insurance

Job summary

Cohere Health is seeking a Manager, Clinical Escalations to build and lead the Escalations Program within Clinical Operations. You will partner with Client Success, Clinical Operations, Compliance, and leadership to ensure timely, compliant resolution of escalations while protecting Cohere Health's operational integrity.

The role requires a structured approach to program development, strong customer service instincts, and a focus on improving the U.S. healthcare experience.

Qualifications

• Bachelor's degree in healthcare or related field.
• 3+ years in utilization management operations.
• Experience communicating with external clients and providers.
• Understanding of healthcare regulations and accreditation.
• Advanced data analysis and spreadsheet skills.
• Experience implementing process improvements.
• Ability to navigate ambiguity and lead a cross-functional program.
• Familiarity with ticketing or project management software is a plus.
• Leadership experience is a plus.

Responsibilities

• Stand up and lead the Escalations Program, including intake, triage, severity classifications, and reporting.
• Serve as primary owner for escalations, ensuring timely categorization, assignment, and resolution.
• Monitor follow-up actions and hold teams accountable for closure.
• Track regulatory and contractual response times and mitigate risks.
• Handle executive escalations with discretion and professionalism.
• Provide timely communication to Cohere leadership on high-stakes issues.
• Lead the Escalations Analyst and develop dashboards on trends and performance.
• Collaborate with Client Success, Clinical Ops, Compliance, Product, and other teams to address root causes.
• Develop and maintain SOPs, playbooks, and templates for escalations.

Skills

Clinical leadership

Utilization management

Regulatory knowledge

Client communications

Process improvement

Data analysis

CRM usage

JIRA

Monday.com

Cross-functional collaboration

Education

Bachelor's degree in healthcare

Tools

CRM

JIRA

Monday.com

Job description

Opportunity Overview

We are seeking a Manager, Clinical Escalations to join our Clinical Process and Standards team. In this role, you will build and lead Cohere Health's Escalations Program within Clinical Operations. You'll partner closely with Client Success, Clinical Operations, Compliance, and leadership to ensure provider and/or client escalations are resolved effectively and efficiently while protecting Cohere's operational integrity and regulatory commitments. The ideal candidate brings strong customer service instincts, a structured approach to program development, and a customer focused presence to effectively manage sensitive escalations.

What you'll do

• Stand up the Escalations Program: Design and implement a formal escalation framework, including intake processes, triage criteria, severity classifications, tracking mechanisms, and reporting cadences - transitioning this function from the Client Success team into a dedicated program.
• Triage and manage client and provider complaints: Serve as the primary point of accountability for all incoming escalations, ensuring each is categorized, assigned, and resolved according to defined workflows.
• Ensure follow-up and resolution: Monitor all open escalations to confirm that follow-up actions are performed, completed, and documented. Hold internal teams accountable for timely closure.
• Meet mandatory response times: Track and enforce compliance with all regulatory and contractual response time requirements. Proactively flag risks and implement corrective actions when TATs are at risk.
• Handle executive escalations with care: Manage high-sensitivity escalations involving executive-level clients or providers with discretion, professionalism, and a solutions-oriented approach.
• Escalate proactively within the organization: Ensure Cohere leadership is never caught off guard - provide timely, clear communication to internal leaders on escalations that carry reputational, regulatory, or relationship risk.
• Lead and develop the Escalations Analyst: Manage, coach, and support one direct report responsible for escalation tracking, data analysis, and reporting.
• Report on escalation trends and performance: Develop dashboards and regular reporting to track escalation volume, resolution rates, TAT compliance, root causes, and trends. Use data to drive continuous improvement.
• Collaborate cross-functionally: Partner with Client Success, Clinical Operations, Compliance, Product, Clinical Content, and other teams to address systemic issues surfaced through escalations and improve the overall client and provider experience.
• Develop and maintain escalation documentation: Create and maintain standard operating procedures (SOPs), escalation playbooks, and communication templates.

What you'll need

• Bachelor's degree in healthcare
• Active clinical licensure in state of residence (RN, PT/OT/SLP considered)
• 3+ years of experience in utilization management operations
• Experience in external client, provider, and/or member communications
• Knowledge of healthcare regulations and accreditation (CMS, Medicaid, JCAHO)
• Proficiency with spreadsheet functions, including data analysis and drawing quantitative conclusions
• Experience implementing process improvements
• Ability to function independently and navigate ambiguity to build a cross-functional program
• Strong problem-solving skills with a customer focus
• Passion for improving the U.S. healthcare system and helping ensure every patient receives the best care possible
• Familiarity with ticketing or project management software (e.g., CRM, JIRA, Monday.com) is a plus
• Demonstrated success implementing new programs is a plus
• People leadership experience is a plus
• Experience managing escalations in a multi-client or multi-health-plan environment is a plus
• Familiarity with root cause analysis (RCA) methodologies and corrective action plan (CAP) development is a plus

Pay & Perks

The salary range for this position is $116,000 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.

• 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
• Flex Time Off + company holidays
• Up to 14 weeks of paid parental leave
• Pet insurance

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 co