Remote Senior Clinical Integrity & UM Leader

Define Ventures; United States; On-site; USD 108,000 - 125,000; Full time

Benefits offered by this job

Health insurance

401(k) with match

Paid parental leave

Pet insurance

Flexible spending account

Job summary

Cohere Health is seeking a Manager, Clinical Integrity to ensure clinical programs and AI‑enabled solutions meet regulatory requirements and client commitments. You’ll collaborate with Clinical Ops, Product, Engineering, and Legal to translate clinical strategy into scalable processes.

Leading governance, documentation, and hands‑on validation, you’ll drive operational readiness and client success across multiple lines of business. Remote work with travel offered.

Qualifications

• Active, unrestricted clinical license (RN/PT/OT/SLP).
• 5+ years in UM, Clinical Ops, or health plan ops; 2+ in leadership.
• Knowledge of Medicare Advantage, Medicaid, Commercial, Marketplace UM; CMS rules.

Responsibilities

• Audit clinical products and workflows for evidence‑based practice and client expectations.
• Write and refine clinical requirements, user stories, and acceptance criteria.
• Lead UAT, create test scripts, document defects, track release readiness.
• Flag gaps vs. SLAs and drive remediation.
• Create governance docs, SOPs, playbooks, training materials.

Skills

UM expertise

Clinical operations

Leadership

Regulatory compliance

Cross-functional collaboration

AI-enabled workflows

Education

RN/PT/OT/SLP license

Bachelor’s in Nursing/Healthcare Administration

Master’s degree (bonus)

Tools

InterQual

MCG

Lean Six Sigma

UAT/QA tools

Job description

Cohere Health is seeking a Manager, Clinical Integrity to ensure clinical programs and AI‑enabled solutions meet regulatory requirements and client commitments. You’ll collaborate with Clinical Ops, Product, Engineering, and Legal to translate clinical strategy into scalable processes.

Leading governance, documentation, and hands‑on validation, you’ll drive operational readiness and client success across multiple lines of business. Remote work with travel offered.