[Hiring] RN Reviewer @Cohere Health

Role Description

The RN Reviewer position is a crucial role in our organization — in this role you are responsible for performing a full range of activities that will positively impact the organization and contribute to guiding the strategic operations for the company.

As an RN Reviewer, you will perform:

• Prospective review (prior authorization) admission
• Concurrent and retrospective reviews according to established criteria and protocols
• Assessment of medical appropriateness of clinical requests from providers

You will work closely with Medical Directors and other Cohere Health staff to ensure appropriate cost-effective care by applying your clinical knowledge and critical thinking skills to assess:

• Medical necessity of inpatient admissions
• Outpatient services and procedures
• Provider out of network requests

You will be required to review Commercial, Medicare, and Medicaid lines of business.

This position offers the ability to make a substantive mark in simplifying the way healthcare is delivered and contributes to an up and coming company with exponential growth opportunity.

Qualifications

• Strong communication and collaboration skills across remote teams
• Customer-focused mindset and ability to stay calm under pressure
• Adaptability in a fast-moving, startup environment
• Solid understanding of utilization and case management programs
• Organized, detail-oriented, and comfortable managing multiple priorities
• Knowledge of NCQA/CMS standards; proficiency with MCG (CareWebQI a plus)

Requirements

• Active, unencumbered RN license (state of residence)
• 3+ years of clinical experience
• Utilization Management experience
• Experience in acute or post-acute settings
• Comfortable using Mac and Google Workspace
• Strong communication skills and continuous improvement mindset

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
• Up to 184 hours (23 days) of PTO per year + company holidays
• Up to 14 weeks of paid parental leave
• Pet insurance

The salary range for this position is $33 per hour to $35 per hour; 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.

Interview Process

• Internet Speed Test
• Behavioral Interview(s) with your Hiring Manager!

*Subject to change