Remote Clinical Integrity Leader in Utilization Management

Cohere Health; Boston (MA); On-site; USD 108,000 - 125,000; Full time

Benefits offered by this job

Medical insurance

401K retirement plan with match

Parental leave (up to 14 weeks)

Remote work

Job summary

Cohere Health seeks a technology-savvy clinical leader for the Manager, Clinical Integrity role. You will drive clinical governance, scale programs, and ensure regulatory alignment while partnering across Clinical Operations, Product, and Engineering.

Lead hands-on UAT, develop governance and SOPs, and contribute to AI-enabled solutions. Remote role with ~10% travel, benefits included.

Qualifications

• Active, unrestricted clinical license and a Bachelor's degree in Nursing, Therapy, Healthcare Administration, or related field.
• 5+ years of progressive UM or clinical operations experience; 2+ in leadership.
• Strong knowledge of Medicare Advantage, Medicaid, Commercial, and Marketplace UM; CMS regs.
• Experience shaping clinical workflows with Product and Technology teams.
• Hands-on with documentation, testing workflows, and process tooling.
• Excellent communication and stakeholder influence without formal authority.
• Bonus: Master's degree or AI-enabled workflows experience; familiarity with InterQual/MCG; Lean/Six Sigma/Agile/PM certs; UAT/QA exposure.

Responsibilities

• Perform clinical reviews of product, workflows, and programs to ensure evidence-based practice and regulatory alignment.
• Write and refine clinical requirements, user stories, and acceptance criteria for UM workflows and AI capabilities.
• Own operational readiness: run UAT, build test scripts, document defects, track release readiness.
• Audit client commitments and SLAs against product capabilities and drive remediation.
• Build and maintain governance docs, SOPs, playbooks, and training materials for consistent workflows.
• Collaborate cross-functionally with Clinical Operations, Product, Engineering, Client Success, Compliance, Legal, and Clinical Strategy.
• Support business growth with clinical assessments, RFP/RFI responses, and feasibility reviews for new clients.

Skills

Utilization Management

Leadership

Clinical Operations

Regulatory Compliance

Education

Bachelor's degree in Nursing, Therapy, Healthcare Administration, or related field

Tools

InterQual

MCG

Lean/Six Sigma/Agile/PM

Job description

Cohere Health seeks a technology-savvy clinical leader for the Manager, Clinical Integrity role. You will drive clinical governance, scale programs, and ensure regulatory alignment while partnering across Clinical Operations, Product, and Engineering.

Lead hands-on UAT, develop governance and SOPs, and contribute to AI-enabled solutions. Remote role with ~10% travel, benefits included.