Senior Inpatient Nurse Auditor

Cohere Health; United States; On-site; USD 75,000 - 85,000; Full time

Job summary

Cohere Health is seeking a clinical reviewer to enhance their inpatient product through clinical expertise and AI. You will review cases, identify patterns, and contribute to algorithm design, collaborating in a dynamic, growth-oriented environment focused on patient-specific care. This role requires strong nursing experience and analytical skills.

Benefits

Health insurance

401k

Bonus

Qualifications

• Requires a Registered Nurse (RN) license.
• 7+ years of experience in payer UM reviews for inpatient authorizations.
• 3+ years in acute care hospital settings as a bedside nurse.

Responsibilities

• Review historical inpatient admission authorizations.
• Synthesize patterns across reviews and help design algorithms.
• Assist in building ML models that read clinical notes.

Skills

Clinical Rigor

Analytical

Leadership

Communication

Technology Use

Education

Associate or Bachelor’s degree in Nursing

Tools

UM review tools

MacBook

Slack

Google Suite

Job description

Cohere Health is a fast-growing clinical intelligence company that’s improving lives at scale by promoting the best patient-specific care options, using cutting-edge AI combined with deep clinical expertise. In only four years our solutions have been adopted by health plans covering over 15 million lives, while our revenues and company size have quadrupled. That growth combined with capital raises totaling $106M positions us extremely well for continued success. Our awards include: 2023 and 2024 BuiltIn Best Place to Work; Top 5 LinkedIn Startup; TripleTree iAward; multiple KLAS Research Points of Light awards, along with recognition on Fierce Healthcare's Fierce 15 and CB Insights' Digital Health 150 lists.

Opportunity Overview:

Working on a small, fast-paced team, and reporting into the Director of Commercial Strategy, you will play a foundational role in the development and delivery of an Cohere’s inpatient product, which combines deep clinical expertise and cutting edge AI to improve clinical review accuracy and efficiency for inpatient admission authorizations. You will apply your clinical expertise to review historical cases and synthesize review patterns as a key input to automation build.

Last but not least: People who succeed here are empathetic teammates who are candid, kind, caring, and embody our core values and principles . We believe that diverse, inclusive teams make the most impactful work. Cohere is deeply invested in ensuring that we have a supportive, growth-oriented environment that works for everyone.

What you will do:

• Review historical inpatient admission authorizations
• Synthesize patterns across reviews
• Help design algorithms for evaluating inpatient admission medical necessity
• Help build ML models that read clinical notes
• Registered Nurse (RN), associate or bachelor’s degree
• 7+ years of experience conducting payer UM reviews for acute inpatient authorizations
• 3+ years of experience in acute care hospital setting as a bedside nurse
• Clinical Rigor: Consistently performs high quality reviews, demonstrating strong command of complex cases
• Operational Expertise: Deep understanding of payer end-to-end inpatient UM workflows, regulatory requirements (e.g., CMS 2MN Rule), and guidelines (i.e., MCG, IQ)
• Analytical: Ability to identify patterns across reviews, summarize in a report, and generate actionable data-driven recommendations
• Communication: Proactive, comprehensive, clear, and concise (a)synchronous communication
• Technology Use: Proficient in key technology applications (e.g., MacBook, Slack, Google Suite, UM review tools)
• Leadership: Go-to resource for peers on best practices, and drives continuous improvement across the UM team
• Ownership: Takes ownership of work and is a self-starter
• Agility: Comfort operating in a fast-paced startup environment
• Perspective on AI: Passion for and conceptual understanding of how AI can be used to optimize UM
• Entrepreneurial: Natural inclination to look for ways to improve the status quo

We can’t wait to learn more about you and meet you at Cohere Health!

Equal Opportunity Statement:

Cohere Health is an Equal Opportunity Employer. We are committed to fostering an environment of mutual respect where equal employment opportunities are available to all. To us, it’s personal.

The salary range for this position is $75,000 to $85,000 annually; as part of a total benefits package which includes health insurance, 401k and bonus. In accordance with state applicable laws, Cohere is required to provide a reasonable estimate of the compensation range for this role. Individual pay decisions are ultimately based on a number of factors, including but not limited to qualifications for the role, experience level, skillset, and internal alignment.

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