Remote Director, Clinical Escalations & Programs

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

Benefits offered by this job

Medical, dental, vision, life, and EAP

401K retirement plan with companymatch

Up to 14 weeks paid parental leave

Job summary

Cohere Health is seeking a Manager of Clinical Escalations to lead the Escalations Program within Clinical Operations. You will design processes, triage for client and provider escalations, and partner with success, compliance and leadership to protect regulatory commitments and client relationships.

The role is fully remote with about 10% travel across the United States. Ideal candidates have clinical licensure, strong program development experience, and a customer-focused approach to sensitive

Qualifications

• Bachelor's degree in healthcare (required).
• Active clinical licensure in state of residence (RN, PT/OT/SLP considered).
• 3+ years in utilization management operations.
• Experience in external client, provider, and/or member communications.
• Knowledge of healthcare regulations and accreditation (CMS, Medicaid, JCAHO).
• Proficiency with spreadsheets, data analysis, and drawing quantitative conclusions.
• Experience implementing process improvements.
• Ability to operate independently and navigate ambiguity in cross-functional programs.
• Strong problem-solving skills with a customer focus.
• Passion for improving U.S. healthcare and patient care.
• Familiarity with ticketing or project management software (CRM, JIRA, Monday.com) is a plus.
• Leadership experience is a plus.
• Experience managing escalations in multi-client or multi-health-plan environments is a plus.
• Familiarity with RCA methodologies and CAP development is a plus.

Responsibilities

• Stand up and lead the Escalations Program with defined workflows and reporting.
• Triage and manage client and provider escalations, ensuring proper categorization and assignment.
• Monitor follow-up actions and ensure timely resolutions.
• Track regulatory and contractual response times and flag risks.
• Handle executive escalations with discretion and professionalism.
• Escalate proactively and communicate with Cohere leadership on high-risk matters.
• Lead and develop the Escalations Analyst to track data and reporting.
• Report on escalation trends, volumes, and performance.
• Collaborate cross-functionally to address systemic issues surfaced through escalations.
• Develop and maintain SOPs, escalation playbooks, and templates.

Skills

Customer service instincts

Program development

Leadership

Data analysis

Cross-functional collaboration

Problem solving

Ambiguity navigation

Customer focus

Education

Bachelor's degree in healthcare

Tools

CRM

JIRA

Monday.com

Job description

Cohere Health is seeking a Manager of Clinical Escalations to lead the Escalations Program within Clinical Operations. You will design processes, triage for client and provider escalations, and partner with success, compliance and leadership to protect regulatory commitments and client relationships.

The role is fully remote with about 10% travel across the United States. Ideal candidates have clinical licensure, strong program development experience, and a customer-focused approach to sensitive