Remote Clinical Policy Architect

Cohere Health; United States; Remote; USD 65,000 - 80,000; Full time

Benefits offered by this job

Fully remote work

Medical, dental, vision, life, & E

Employee Assistance Program

401K with company match

Flexible spending & Health Savings

Parental leave (up to 14 weeks)

Job summary

Cohere Health is seeking a Clinical Policy Configuration Specialist to join our Clinical Operations team. You will configure and maintain medical coverage policies within our platform, collaborating with clinical experts, product, engineering, and operations to ensure compliant, evidence-based policy implementation.

The role supports scalable, high-quality clinical decision-making. You’ll work on policy configuration, QA validation, and staying current with policy updates, while helping

Qualifications

• 2+ years in utilization management, medical policy development, health tech assessment, or payer policy configuration.
• Strong understanding of medical coverage policies and prior authorization criteria.
• Familiarity with ICD-10, HCPCS, CPT coding.
• Proficient with Word, Excel, Google Drive, Confluence, Jira.
• Strong attention to detail with QA/validation experience.
• Ability to work independently and as part of a team.

Responsibilities

• Configure and maintain medical coverage policies within Cohere’s product platform to ensure accuracy, consistency, and compliance with industry standards.
• Conduct quality assurance reviews and testing of policy configurations to validate functionality and clinical appropriateness.
• Monitor updates on medical coverage policies to adjust policies and maintain compliance.
• Serve as a subject matter expert on medical coverage policies, providing guidance and support to internal teams and customers.
• Address inquiries and feedback regarding policy configurations, ensuring alignment with payers, providers, and reviewers.
• Collaborate with clinical experts, product managers, engineers, medical writers, and reviewers to optimize policy implementation and usability.

Skills

Utilization management

Medical policy development

Health technology assessment

Payer policy configuration

Attention to detail

Team collaboration

Education

Bachelor’s Degree in Nursing (BSN) or equivalent

Tools

Microsoft Word

Microsoft Excel

Google Drive

Confluence

Jira

Job description

Cohere Health is seeking a Clinical Policy Configuration Specialist to join our Clinical Operations team. You will configure and maintain medical coverage policies within our platform, collaborating with clinical experts, product, engineering, and operations to ensure compliant, evidence-based policy implementation.

The role supports scalable, high-quality clinical decision-making. You’ll work on policy configuration, QA validation, and staying current with policy updates, while helping