Manager, Clinical Operations

Opportunity Overview:

Cohere’s Clinical Operations team is responsible for ensuring that our healthcare partners are supported throughout their lifecycle of using the platform. The Manager, Clinical Operations position is a crucial role in our organization. In this role, you are responsible for coaching, mentoring, evaluating and developing the Reviewer team leadership and front line staff. The Manager will use established operational tools to ensure all Nurse staff and leaders are meeting or exceeding performance metrics and quality standards established by the leadership team.

As a Manager, you will be responsible for providing daily operational guidance to the leadership and Nurse Reviewers to allow them to meet or exceed operational objectives and metrics. You will leverage both your creative skills and communication skills to promote a high performing clinical team.

The Manager, Clinical Operations will be highly organized in order to plan daily operational activities and provide oversight of the Nurse Review teams. You will be responsible to work with the Sr. Director and leadership to give input into the team’s future strategy to meet the organization’s goals. You will use your professionalism, people management skills, and communication skills to inspire the team to meet or exceed all performance standards. At a growing organization, this is a position that offers the ability to make a substantive mark on the company and its partners with exponential growth opportunities.

What you’ll do:

• Oversee the supervisors leading Prior Auth Nurse Reviewers, Concurrent Review Nurses or Appeals Specialists teams
• Work closely with the leadership team to mentor and develop supervisors and downstream team members
• Review the nurse productivity reports daily per vertical and provide feedback to the supervisors, managing performance to ensure consistency
• Capture process efficiency ideas from the team and work with the appropriate stakeholders to recommend and lead changes needed to improve nurse efficiency
• Meet individually with all supervisor direct reports on a weekly or bi-weekly cadence to develop solid work relationships with each team member and to share any performance feedback
• Assists with recruiting, interviewing, and training of employees; identifies educational opportunities and knowledge gaps and constructs performance improvement plans, as needed
• Develops and maintains strong working relationships with other leaders and provides cross coverage, as needed
• Working with the Supervisors, track hourly nurse productivity, keeping the Director informed on productivity results, as needed
• Advises key leadership on process and system enhancement opportunities
• Exemplifies the core values of Cohere Health
• May be asked to help with other projects as needed

What you’ll need:

• 5+ years of supervisory/management experience
• Registered Nurse with an active and unencumbered license to practice
• Knowledge of NCQA/CMS requirements
• Experience using MCG, CMS NCDs/LCDs
• 3+ years Prior Authorization, Utilization Management and/or Appeals experience required
• Excellent computer skills and familiarity with a Mac
• Experience supervising and training in a remote work environment

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

The salary range for this position is $80,000 - $100,000 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.

Interview Process*:

1. Connect with Talent Acquisition for a Preliminary Phone Screening
2. Meet your Hiring Manager!
3. Behavioral Interview(s)

*Subject to change

About Cohere Health:

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.

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.

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.

#LI-Remote

#BI-Remote