[Remote] Clinical Policy Configuration Specialist

Note: The job is a remote job and is open to candidates in USA. Cohere Health is a company focused on optimizing healthcare processes through its clinical intelligence platform. They are seeking a Clinical Policy Configuration Specialist to ensure medical coverage policies are accurately configured and compliant, collaborating with clinical experts and cross-functional teams to enhance policy implementation.ResponsibilitiesConfigure and maintain medical coverage policies within Cohere’s product platform to ensure accuracy, consistency, and compliance with industry standardsConduct quality assurance reviews and testing of policy configurations to validate functionality and clinical appropriatenessMonitor updates on medical coverage policies to adjust policies and maintain complianceServe as a subject matter expert on medical coverage policies, providing guidance and support to internal teams and customersAddress internal/external customer inquiries and feedback regarding policy configurations, ensuring alignment with payers, providers, and reviewersCollaborate cross-functionally with clinical experts, product managers, engineers, medical writers, and utilization management reviewers to optimize policy implementation and usabilitySkills2+ years of related experience working in utilization management, medical policy development, health technology assessment, or payer policy configurationStrong understanding of medical coverage policies and prior authorization criteriaFamiliarity 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 processesAbility to work independently and as part of a teamYou are passionate about improving the U.S. healthcare system and helping ensure every patient receives the best care possibleYou are self-directed, confident, and thrive working in a fast-paced startup environmentBachelor's Degree in Nursing (BSN) or equivalent clinical backgroundBenefitsFully remote opportunity with about 5% travelMedical, dental, vision, life, disability insurance, and Employee Assistance Program401K retirement plan with company match; flexible spending and health savings accountFlex Time Off + company holidaysUp to 14 weeks of paid parental leavePet insuranceCompany OverviewCohere Health is a SaaS company that focuses on improving the efficiency and effectiveness of healthcare delivery. It was founded in 2019, and is headquartered in Boston, Massachusetts, USA, with a workforce of 501-1000 employees. Its website is https://coherehealth.com.