[Hiring] Medical Director Therapy @Cohere Health

Role Description

We are looking for physicians who have expertise in PM&R, Family Practice, Pediatrics, or Internal Medicine to deliver on Cohere’s program by determining the medical appropriateness of services by reviewing clinical information and applying evidence-based guidelines. Reporting to the Managing Medical Director for Cohere Health, this is a critical role in a company that is rapidly scaling to impact millions of patients. This is a fast-paced environment that favors people who are able to learn quickly, be hands-on, handle ambiguity, and communicate effectively with people of different backgrounds and perspectives.

What you’ll do:

• Support the clinical content team in reviewing the company’s clinical decision guidelines and evidence-based literature.
• Provide expert input on content for influencing physicians in medical care to improve the quality of patient outcomes.
• Provide timely medical reviews that meet Cohere’s stringent quality and timeliness parameters.
• Provide clinical determinations based on evidence-based criteria while utilizing clinical acumen and knowledge of evidence-based literature and medical society guidelines.
• Clearly and accurately document all communication and decision-making in Cohere workflow tools, ensuring a member and provider can easily reference and understand your decision.
• Use correct templates for documenting medical necessity decisions during case review.
• Conduct timely peer-to-peer discussions with treating providers to clarify clinical information and to explain review outcome decisions, including feedback on alternate treatment based on medical necessity criteria and evidence-based research.
• Demonstrate the highest level of professionalism, accountability, and service in your interactions with Cohere teammates and providers.
• Support projects specific to building the team's clinical expertise and efficiency, as delegated.
• Support the team on operational improvements and member/provider experience involving clinical review tasks, as delegated.

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 - reviewers must maintain necessary credentials to retain the position.
• 5+ years of clinical practice beyond residency/fellowship in above specialties.
• Understanding of Therapy programs (PT / OT / SLP) on outpatient and inpatient basis.
• Excels in a matrix organization.
• Comfortable with technology - willing and able to learn new software tools.
• Understanding of managed care regulatory structure and processes.
• Detail-oriented, flexible, and able to work autonomously with little supervision.
• 1+ years of managed care utilization review experience in Therapy (PT/OT/SLP) highly desirable.
• Licensure in AR, MO, MN, NC, IN, TX, NE is highly desirable - you should be willing to obtain additional state licenses with Cohere's support.

Benefits

• 💻 Fully remote opportunity with about 5% 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).

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.