Opportunity Overview:
We are seeking a Clinical Quality and Training Specialist to join our Training and Quality team. In this role, you will support clinical quality measurement and performance improvement initiatives focused on inpatient clinical reviews, helping drive operational efficiency while upholding high standards of clinical quality and guidance.
You will partner closely with Clinical Operations to support training and quality programs, applying your subject-matter expertise to deliver feedback, coaching, and development that strengthens team performance. This role requires a strong foundation in quality analysis, training, and continuous improvement, along with the flexibility to manage both day-to-day QA responsibilities and longer-term initiatives in a fast-paced environment.
What you’ll do:
- Conduct quality audits of inpatient clinical determinations to ensure alignment with clinical guidelines and quality standards
- Analyze QA findings and translate insights into actionable recommendations for operational leaders and cross-functional partners
- Provide coaching and feedback to improve clinical decision accuracy, guideline adherence, and overall team performance
- Develop and maintain SOPs, job aids, workflow documentation, and training materials for inpatient review processes
- Facilitate onboarding and ongoing training for Clinical teams using adult learning principles and subject-matter expertise
- Partner cross-functionally with Product, Clinical, Client Services, and Operations to implement workflow updates, monitor quality trends, and report performance insights to leadership
What you’ll need:
- Active RN license
- 2+ years of experience reviewing inpatient utilization management / coverage determinations, with strong familiarity with NCQA and CMS guidelines
- Experience applying clinical guidelines (e.g., LCD/NCD) to medical necessity or authorization decisions
- Experience conducting quality audits, performance reviews, or QA processes in a clinical operations or utilization management environment
- Ability to deliver coaching, feedback, or training to improve clinical decision accuracy and guideline adherence
- Strong analytical skills with experience identifying quality trends, root causes, and opportunities for improvement
- Excellent written and verbal communication skills with the ability to partner effectively with operational and cross-functional stakeholders
- Proficiency with tools such as Google Workspace (Sheets, Docs, Forms) and comfort working with data, dashboards, or quality reporting
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
🏝️ Flexible Time Off + Company Holidays
👶 Up to 14 weeks of paid parental leave
🐶 Pet insurance
The salary range for this position is $70,000 to $80,000 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.
This role is not eligible for hire in: AK, CA, CO, HI, NY, or WA.
Interview Process*:
- Connect with Talent Acquisition for a Preliminary Phone Screening
- Hiring Manager Interview
- Cross Functional Interview
- Leadership Interview
*Subject to change
About Cohere Health:
Cohere Health’s clinical intelligence platform delivers AI-powered solutions that streamline access to quality care by improving payer-provider collaboration, cost containment, and healthcare economics. Cohere Health works with over 660,000 providers and handles over 12 million prior authorization requests annually. Its responsible AI auto-approves up to 90% of requests for millions of health plan members.
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 claims validation, we’re creating a transparent healthcare ecosystem that reduces waste, improves payer-provider collaboration and patient outcomes, and ensures providers are paid promptly and accurately.
Cohere Health’s innovations continue to receive industry wide recognition. We’ve been named to the 2025 Inc. 5000 list and in the Gartner® Hype Cycle™ for U.S. Healthcare Payers (2022-2025), and ranked as a Top 5 LinkedIn™ Startup for 2023 & 2024. Backed by leading investors such as Deerfield Management, Define Ventures, Flare Capital Partners, Longitude Capital, and Polaris Partners, Cohere Health drives more transparent, streamlined healthcare processes, helping patients receive faster, more appropriate care and higher-quality outcomes.
The Coherenauts, as we call ourselves, who succeed here are empathetic teammates who are candid, kind, caring, and embody our core values and principles. We believe that diverse, inclusive teams make the most impactful work. Cohere is deeply invested in ensuring that we have a supportive, growth-oriented environment that works for everyone.
We can’t wait to learn more about you and meet you at Cohere Health!
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.
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