Clinical Policy Configuration Specialist

Responsibilities

• Configure and maintain medical coverage policies within Cohere's product platform to ensure accuracy, consistency, and compliance with industry standards.
• Conduct quality assurance reviews and testing of policy configurations to validate functionality and clinical appropriateness.
• Monitor updates on medical coverage policies to adjust policies and maintain compliance.
• Serve as a subject matter expert on medical coverage policies, providing guidance and support to internal teams and customers.
• Address internal/external customer inquiries and feedback regarding policy configurations, ensuring alignment with payers, providers, and reviewers.
• Collaborate cross-functionally with clinical experts, product managers, engineers, medical writers, and utilization management reviewers to optimize policy implementation and usability.

Requirements

• 2+ years of related experience working in utilization management, medical policy development, health technology assessment, or payer policy configuration.
• Strong understanding of medical coverage policies and prior authorization criteria.
• Familiarity with healthcare data structures, and clinical coding (ICD-10, HCPCS, CPT).
• Must be knowledgeable of multiple software programs (Microsoft Word, Excel, Google Drive, Confluence, Jira)
• Strong attention to detail with experience in quality assurance and validation processes.
• Ability to work independently and as part of a team
• You are passionate about improving the U.S. healthcare system and helping ensure every patient receives the best care possible
• You are self-directed, confident, and thrive working in a fast-paced startup environment
• Bachelor's Degree in Nursing (BSN) or equivalent clinical background
• Pay & Perks:
• 💻 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!
• Team Interview
• Cross Functional Interview
• *Subject to change
• About Cohere Health:
• The Coherenauts, as we call ourselves, who succeed here are empathetic teammates who are candid, kind, caring, and embody our core valu

Benefits

Additional Information

Opportunity Overview: We are seeking a Clinical Policy Configuration Specialist to join our Clinical Operations team. In this role, you will ensure medical coverage policies are accurately configured, maintained, and compliant within Cohere's platform, directly supporting high-quality, consistent clinical decision-making. You'll partner closely with clinical experts, product, engineering, and operations teams to optimize policy implementation - making this an opportunity to shape how evidence-based care is delivered at scale.

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