[Hiring] Sr. Director, Clinical Operations @Cohere Health

Role Description

The Sr. Director, GIC India Clinical Operations is a foundational leadership role responsible for establishing, scaling, and managing the clinical RN review function within Cohere Health's Global Innovation Center (GIC) in Hyderabad, India. This leader will build a high-performing team of US NCLEX-certified Registered Nurses (NCLEX-RNs) who perform prospective, concurrent, and retrospective clinical reviews for prior authorization cases on behalf of Cohere Health's US payer clients.

The Sr. Director will be accountable for the end-to-end clinical operations delivery from the India GIC, ensuring that RN reviewers assess medical records and clinical documentation for appropriateness and medical necessity in strict alignment with clinical guidelines (including MCG Care Guidelines), Cohere Health internal criteria, National and Local Coverage Determinations (NCD/LCD), and regulatory standards (CMS, NCQA, HIPAA, HITRUST).

This role operates within Cohere Health's push-pull delivery framework, where the US retains program ownership, process design, client relationships, and final clinical determination authority, while the India GIC executes clinical review operations per established SOPs and work instructions.

This is a highly strategic role requiring a leader who can bridge US healthcare clinical operations with India-based talent delivery, foster a culture of clinical excellence, and drive continuous quality improvement in a fast-paced, technology-driven environment.

Qualifications

• Bachelor's degree in Nursing (BSN) — Required
• Active, US Registered Nurse license (NCLEX-RN) — Required
• Minimum 12–15 years of progressive experience in clinical operations, utilization management, and/or healthcare operations, with at least 5 years in a senior leadership role
• Knowledge and experience in utilization review / utilization management, including prospective (prior authorization), concurrent, and retrospective review
• Proven experience setting up and managing clinical operations in a GCC/GIC/BPO/offshore environment, preferably serving US healthcare payer clients
• Demonstrated expertise in US healthcare delivery systems, payer operations, and the prior authorization lifecycle across Commercial, Medicare, and Medicaid lines of business
• Hands-on experience with clinical criteria sets including MCG Care Guidelines, InterQual, and/or equivalent evidence-based criteria
• Experience managing NCLEX-certified RN teams in India or other offshore locations
• Knowledge of clinical algorithms, care pathways, and utilization management across the care continuum (acute care, post-acute care, ambulatory, outpatient)
• Experience with CMS regulatory requirements, HIPAA, and HITRUST compliance frameworks

Requirements

• Proven track record of building clinical teams from the ground up in offshore settings
• Experience managing 50+ clinical professionals, including hiring, training, performance management, and workforce planning
• Demonstrated ability to lead cross-border, cross-functional teams across US and India time zones
• Strong executive presence with the ability to influence and collaborate with senior stakeholders (C-suite, Medical Directors, Health Plan clients)
• Track record of driving continuous quality improvement and operational excellence in clinical settings

Benefits

• Location: Remote in India preferably in southern states.
• Work Schedule: Shift schedules for real-time collaboration with US clinical teams; flexibility for extended hours during client launches, audits, or client requirements.
• Travel: Occasional travel to the United States (estimated 2 per year) for leadership summits and training programs.
• Technology: Proficiency with Google Workspace (G Suite), Zoom, and Mac-based environments preferred; working knowledge of Cohere Unify™ platform (training will be provided).
• Ability to commute/relocate: Hyderabad, Telangana: Reliably commute or planning to relocate before starting work (Preferred).

Company Description

Cohere Health’s clinical intelligence platform and agentic AI-powered solutions connect health plans’ strategic goals and providers’ needs, optimizing the speed, cost, and quality of care. With an enterprise approach that streamlines payer-provider decision-making across the care continuum–including policy, prior authorization, payment accuracy, and more–the company improves collaboration and reduces burden, resulting in up to 8x ROI and 94% provider satisfaction.

With the acquisition of ZignaAI, we expanded our AI-native platform with a comprehensive Payment Integrity Suite that spans data mining, clinical and coding validation, authorization and claims reconciliation, and end-to-end payment integrity services across pre- and post-pay workflows. By connecting clinical and payment insights, our transparent, AI-powered solutions help health plans proactively improve payment accuracy, reduce waste and vendor dependency, strengthen provider relationships, and build smarter, more efficient payment integrity programs.

Cohere Health’s innovations continue to receive industry-wide recognition. We’ve been recognized on TIME’s World Top HealthTech Companies 2025 list, the 2025 Inc. 5000 list, in the Gartner® Hype Cycle™ for U.S. Healthcare Payers (2022-2025), and ranked as a Top 5 LinkedIn™ Startup for 2023 & 2024.