[Hiring] Clinical Integrity Director @Cohere Health

Role Description

We are seeking a technology-savvy clinical leader with strong Utilization Management (UM) expertise to join Cohere Health as the Clinical Integrity Director. Reporting to the Vice President of Clinical Integrity, this role is a program-level operational leader responsible for managing the day-to-day integrity, governance, and readiness of Cohere's clinical programs and technology-enabled solutions.

This leader manages clinical integrity workstreams end-to-end — from governance documentation and product testing to implementation readiness and cross-functional coordination — ensuring nothing falls through the cracks as Cohere scales.

The Director works across Clinical Operations, Product, Engineering, Client Success, and Compliance to ensure clinical integrity is operationalized consistently. This role requires someone who can manage multiple concurrent workstreams, drive accountability across teams, and step in hands-on when needed.

This is a remote-first role that may require travel to Boston, MA for new hire onboarding and occasional in-person team meetings and company events.

What you’ll do:

• Own and manage clinical integrity governance programs, including reviews, documentation, tracking, frameworks, checklists, and dashboards across all active programs.
• Manage the clinical impact assessment process for policy changes, product updates, and regulatory shifts — escalating findings to the VP as needed.
• Own the clinical requirements pipeline by managing intake, prioritization, and delivery of clinical requirements to Product and Engineering teams.
• Manage the end-to-end process for translating regulatory and clinical changes into product specifications, ensuring timelines and dependencies are tracked.
• Own the operational readiness program for product releases and client implementations, including timelines, milestones, and cross-functional accountability.
• Manage the clinical UAT process: assign testing, review results, triage defects, and ensure resolution before go-live.
• Develop and maintain readiness scorecards providing leadership with clear go/no-go visibility for each release or implementation.
• Serve as a primary operational point of contact for Clinical Integrity across Product, Engineering, Clinical Operations, Compliance, and Client Success.
• Manage preparation of clinical integrity materials for RFPs, RFIs, and client questionnaires.
• Lead clinical readiness activities for new client implementations and conduct feasibility assessments for prospective client requirements.

Qualifications

• Active unrestricted clinical license (RN, PT, OT, or SLP) and a Bachelor's degree in Nursing, Therapy, Healthcare Administration, or related clinical discipline.
• 7+ years of progressive experience in Utilization Management, Clinical Operations, or Health Plan operations, including 3+ years managing programs, projects, or teams.
• Strong knowledge of Medicare Advantage, Medicaid, Commercial, and Marketplace utilization management, as well as CMS regulations, NCQA accreditation standards, and state regulatory requirements.
• Demonstrated experience managing multiple concurrent workstreams and cross-functional projects involving Product, Engineering, and Operations teams in a fast-paced, technology-enabled environment.
• Proven ability to drive accountability, manage timelines, and deliver results through others with strong organizational, communication, and problem-solving skills.
• Master's degree in Healthcare Administration or Business Administration, Lean/Six Sigma/Agile/PMP certification, and experience with clinical UAT programs, InterQual®/MCG®, or AI-enabled clinical workflows are a plus.

Requirements

• Active unrestricted clinical license (RN, PT, OT, or SLP).
• Bachelor's degree in Nursing, Therapy, Healthcare Administration, or related clinical discipline.
• 7+ years of experience in Utilization Management, Clinical Operations, or Health Plan operations.
• 3+ years managing programs, projects, or teams.

Benefits

• Fully remote opportunity with about 10% travel.
• Medical, dental, vision, life, disability insurance, and Employee Assistance Program.
• 401K retirement plan with company match; flexible spending and health savings account.
• Flex Time Off + company holidays.
• Up to 14 weeks of paid parental leave.
• Pet insurance.

Interview Process

• Connect with Talent Acquisition for a Preliminary Phone Screening.
• Meet your Hiring Manager!
• Behavioral Interview(s).