Remote Clinical Integrity Lead: UM & AI Ops

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

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.