Medical Director Therapy

Opportunity Overview

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.

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.

What you’ll do

• Support the clinical content team in reviewing the company’s clinical decision guidelines and evidence based literature
• Provide expert input on content for influencing physicians in medical care to improve the quality of patient outcomes
• Provide timely medical reviews that meet Cohere’s stringent quality and timeliness parameters
• Provide clinical determinations based on evidence-based criteria while utilizing clinical acumen and knowledge of evidence based literature and medical society guidelines
• 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
• Use correct templates for documenting medical necessity decisions during case review
• 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
• Demonstrate the highest level of professionalism, accountability, and service in your interactions with Cohere teammates and providers
• Support projects specific to building the team's clinical expertise and efficiency, as delegated
• Support the team on operational improvements and member/provider experience involving clinical review tasks, as delegated

What you’ll need

• Completed US-based residency program in PM&R, Family Practice, Pediatrics, or Internal Medicine
• 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
• 5+ years of clinical practice beyond residency/fellowship in above specialties
• Understanding of Therapy programs (PT / OT / SLP) on outpatient and inpatient basis
• Excels in a matrix organization
• Comfortable with technology - willing and able to learn new software tools
• Understanding of managed care regulatory structure and processes
• Detail-oriented, flexible, and able to work autonomously with little supervision

• 1+ years of managed care utilization review experience in Therapy (PT/OT/SLP) highly desirable
• Licensure in AR, MO, MN, NC, IN, TX, NE is highly desirable - you should be willing to obtain additional state licenses with Cohere's...