Remote Clinical Integrity & UM Operations Lead

Cohere Health; United States; Remote; USD 108,000 - 125,000; Full time

Benefits offered by this job

Fully remote

Travel ≈ 10%

Health insurance

401K

Flex time off

Parental leave

Pet insurance

Job summary

Cohere Health is seeking a Manager, Clinical Integrity, a hands-on clinical leader with UM expertise. You will ensure integrity across product life cycles, align clinical programs with regulatory standards, and drive scalable governance and tooling.

This role partners with Product, Engineering, and Operations to deliver evidence-based, AI-enhanced solutions. You’ll lead clinical governance activities, author requirements, and support client implementations while advancing a culture of clinical

Qualifications

• RN, PT, OT, or SLP with active, unrestricted license and a relevant bachelor’s degree.
• 5+ years in UM, Clinical Operations, or health plan ops; 2+ years in leadership.
• Knowledge of Medicare Advantage, Medicaid, CMS regulations, and NCQA accreditation.

Responsibilities

• Perform clinical reviews of product, workflows, and programs for evidence-based practice and regulatory alignment.
• Write and refine clinical requirements, user stories, and acceptance criteria for UM workflows and AI-enabled capabilities.
• Own operational readiness: UAT, test scripts, defect tracking, and release readiness.
• Audit client commitments and SLAs; flag gaps and drive remediation.
• Develop governance docs, SOPs, playbooks, and training materials.
• Partner with Clinical Operations, Product, Engineering, Client Success, Compliance, Legal, and Strategy.
• Support growth with clinical assessments, RFP/RFI responses, and feasibility reviews.

Skills

Leadership

Utilization Management

Regulatory knowledge

Cross-functional collaboration

Documentation & testing

Education

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

Job description

Cohere Health is seeking a Manager, Clinical Integrity, a hands-on clinical leader with UM expertise. You will ensure integrity across product life cycles, align clinical programs with regulatory standards, and drive scalable governance and tooling.

This role partners with Product, Engineering, and Operations to deliver evidence-based, AI-enhanced solutions. You’ll lead clinical governance activities, author requirements, and support client implementations while advancing a culture of clinical