<p><strong>Opportunity Overview: </strong></p> <p>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. </p> <p>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.</p> <p><strong>What you’ll do:</strong></p> <ul> <li>Support the clinical content team in reviewing the company’s clinical decision guidelines and evidence based literature </li> <li>Provide expert input on content for influencing physicians in medical care to improve the quality of patient outcomes</li> <li>Provide timely medical reviews that meet Cohere’s stringent quality and timeliness parameters</li> <li>Provide clinical determinations based on evidence-based criteria while utilizing clinical acumen and knowledge of evidence based literature and medical society guidelines</li> <li>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</li> <li>Use correct templates for documenting medical necessity decisions during case review</li> <li>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</li> <li>Demonstrate the highest level of professionalism, accountability, and service in your interactions with Cohere teammates and providers</li> <li>Support projects specific to building the team's clinical expertise and efficiency, as delegated</li> <li>Support the team on operational improvements and member/provider experience involving clinical review tasks, as delegated</li> </ul> <p><strong>What you’ll need:</strong></p> <ul> <li>Completed US-based residency program in PM&R, Family Practice, Pediatrics, or Internal Medicine</li> <li>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</li> <li>5+ years of clinical practice beyond residency/fellowship in above specialties</li> <li>Understanding of Therapy programs (PT / OT / SLP) on outpatient and inpatient basis</li> <li>Excels in a matrix organization</li> <li>Comfortable with technology - willing and able to learn new software tools</li> <li>Understanding of managed care regulatory structure and processes</li> <li>Detail-oriented, flexible, and able to work autonomously with little supervision</li> </ul> <ul> <li>1+ years of managed care utilization review experience in Therapy (PT/OT/SLP) highly desirable</li> <li>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 </li> </ul> <p> </p> <p><strong>Pay & Perks:</strong></p> <p>💻 Fully remote opportunity with about 5% travel</p> <p>🩺 Medical, dental, vision, life, disability insurance, and Employee Assistance Program </p> <p>📈 401K retirement plan with company match; flexible spending and health savings account </p> <p>🏝️ Flex Time Off + company holidays</p> <p>👶 Up to 14 weeks of paid parental leave </p> <p>🐶 Pet insurance </p> <p> </p> <p>The salary range for this position is $210,000 - $260,000 annually; 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. </p> <p> </p> <p><strong>Interview Process*:</strong></p> <p> </p> <ol> <li>Connect with Talent Acquisition for a Preliminary Phone Screening</li> <li>Meet your Hiring Manager!</li> <li>Behavioral Interview(s)</li> </ol> <p> </p> <p>*Subject to change</p> <p> </p> <p><strong>About Cohere Health:</strong></p> <p>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. </p> <p>With the acquisition of ZignaAI, we’ve further enhanced our platform by launching our Payment Integrity Suite, anchored by Cohere Validate™, an AI-driven clinical and coding validation solution that operates in near real-time. By unifying pre-service authorization data with post-service