Remote Medical Director — Therapy & Evidence Reviews

Cohere Health; Northern (KY); Hybrid; USD 210,000 - 260,000; Full time

Job summary

Cohere Health is seeking physicians with PM&R, Family Practice, Pediatrics, or Internal Medicine expertise to assess medical appropriateness of services by reviewing clinical data and applying evidence-based guidelines. You will support the clinical content team, provide expert input to influence care, and ensure timely medical reviews in a fully remote role with about 5% travel.

You will document decisions meticulously, use standard templates, and engage in peer-to-peer discussions to clarify

Qualifications

• Completed US-based residency program in PM&R, Family Practice, Pediatrics, or Internal Medicine.
• Board certification as an MD or DO with a current unrestricted state license to practice medicine.
• 5+ years of clinical practice beyond residency/fellowship in above specialties.
• Licensure in AR, MO, MN, NC, IN, TX, NE is highly desirable and Cohere supports obtaining additional licenses.

Responsibilities

• Review clinical information and apply evidence-based guidelines to determine medical appropriateness.
• Provide expert input on content to influence physicians in medical care and improve outcomes.
• Provide timely medical reviews that meet quality and timeliness parameters.
• Document communication and decision-making clearly in Cohere workflow tools.
• Use templates for documenting medical necessity decisions during case review.
• Conduct peer-to-peer discussions with treating providers to explain decisions and alternatives.
• Demonstrate professionalism and accountability in interactions with team and providers.
• Support projects to grow the team's clinical expertise and efficiency.
• Assist with operational improvements affecting member/provider experience in clinical reviews.

Education

Residency in PM&R / Family Practice / Pediatrics / Internal Medicine

Job description

Cohere Health is seeking physicians with PM&R, Family Practice, Pediatrics, or Internal Medicine expertise to assess medical appropriateness of services by reviewing clinical data and applying evidence-based guidelines. You will support the clinical content team, provide expert input to influence care, and ensure timely medical reviews in a fully remote role with about 5% travel.

You will document decisions meticulously, use standard templates, and engage in peer-to-peer discussions to clarify