Remote Manager, Clinical Escalations & Programs

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

Benefits offered by this job

Fully remote work

Travel up to 10%

Health insurance

401(k) with company match

Paid parental leave

Flexible time off

Employee assistance program

Pet insurance

Job summary

Cohere Health is seeking a Manager, Clinical Escalations to build and lead the Escalations Program within Clinical Operations. You will partner with Client Success, Clinical Operations, Compliance, and leadership to ensure timely, compliant resolution of escalations while protecting Cohere Health's operational integrity.

The role requires a structured approach to program development, strong customer service instincts, and a focus on improving the U.S. healthcare experience.

Qualifications

• Bachelor's degree in healthcare or related field.
• 3+ years in utilization management operations.
• Experience communicating with external clients and providers.
• Understanding of healthcare regulations and accreditation.
• Advanced data analysis and spreadsheet skills.
• Experience implementing process improvements.
• Ability to navigate ambiguity and lead a cross-functional program.
• Familiarity with ticketing or project management software is a plus.
• Leadership experience is a plus.

Responsibilities

• Stand up and lead the Escalations Program, including intake, triage, severity classifications, and reporting.
• Serve as primary owner for escalations, ensuring timely categorization, assignment, and resolution.
• Monitor follow-up actions and hold teams accountable for closure.
• Track regulatory and contractual response times and mitigate risks.
• Handle executive escalations with discretion and professionalism.
• Provide timely communication to Cohere leadership on high-stakes issues.
• Lead the Escalations Analyst and develop dashboards on trends and performance.
• Collaborate with Client Success, Clinical Ops, Compliance, Product, and other teams to address root causes.
• Develop and maintain SOPs, playbooks, and templates for escalations.

Skills

Clinical leadership

Utilization management

Regulatory knowledge

Client communications

Process improvement

Data analysis

CRM usage

JIRA

Monday.com

Cross-functional collaboration

Education

Bachelor's degree in healthcare

Tools

CRM

JIRA

Monday.com

Job description

Cohere Health is seeking a Manager, Clinical Escalations to build and lead the Escalations Program within Clinical Operations. You will partner with Client Success, Clinical Operations, Compliance, and leadership to ensure timely, compliant resolution of escalations while protecting Cohere Health's operational integrity.

The role requires a structured approach to program development, strong customer service instincts, and a focus on improving the U.S. healthcare experience.