Clinical Integrity Manager
AI summary of the role
Hands-on clinical leader managing clinical integrity for Cohere's utilization management and AI-enabled products, ensuring regulatory compliance and client commitments.
What you’ll do
- Perform clinical reviews of products, workflows, and programs to ensure alignment with evidence-based practice, regulatory requirements, and client expectations
- Write and refine clinical requirements, user stories, and acceptance criteria for UM workflows and AI-enabled capabilities, representing clinical integrity in sprint planning
- Own operational readiness: run hands-on UAT, build test scripts, document defects, and track readiness for releases and implementations
- Audit client commitments and SLAs against product capabilities, flag gaps, and drive remediation
What you’ll bring
- Active, unrestricted clinical license as RN, PT, OT, or SLP with Bachelor's degree in Nursing, Therapy, Healthcare Administration, or related field
- 5+ years progressive experience in Utilization Management, Clinical Operations, or health plan operations, including 2+ years in leadership/supervisory capacity
- Strong knowledge of Medicare Advantage, Medicaid, Commercial, and Marketplace UM, plus CMS regulations, NCQA accreditation, and delegation oversight
- Experience partnering with Product and Technology teams to shape clinical workflows and digital solutions
Technologies
UAT · AI-enabled clinical workflows · InterQual · MCG · Lean/Six Sigma · Agile · PM certification
About Cohere Health
Clinical intelligence platform for health plans and risk-bearing providers that automates prior authorization and payment integrity with clinically trained AI and provider-facing workflow integration.
Series C · 500–1000 people
Source and classification
Deployment strategy · Evidence for this classification:
Opportunity Overview: We are seeking a technology-savvy clinical leader with strong expertise in Utilization Management (UM) to join Cohere Health as the Manager, Clinical Integrity. Reporting to the Vice President, Clinical Integrity, this role is a hands-on operational leader responsible for directly executing and maintaining the integrity, scalability, and operational readiness of Cohere's clinical programs and technology-enabled solutions. The Manager works alongside leaders across Clinical Operations, Product, Engineering, Clinical Programs, Client Success, Growth, Implementation, and Clinical Strategy to ensure that clinical integrity is embedded throughout the product lifecycle and operational execution. This leader directly translates enterprise clinical strategy into scalable processes, governance documentation, and day-to-day operational excellence while ensuring Cohere's
More from the job description
Opportunity Overview: We are seeking a technology-savvy clinical leader with strong expertise in Utilization Management (UM) to join Cohere Health as the Manager, Clinical Integrity. Reporting to the Vice President, Clinical Integrity, this role is a hands-on operational leader responsible for directly executing and maintaining the integrity, scalability, and operational readiness of Cohere's clinical programs and technology-enabled solutions. The Manager works alongside leaders across Clinical Operations, Product, Engineering, Clinical Programs, Client Success, Growth, Implementation, and Clinical Strategy to ensure that clinical integrity is embedded throughout the product lifecycle and operational execution. This leader directly translates enterprise clinical strategy into scalable processes, governance documentation, and day-to-day operational excellence while ensuring Cohere's clinical capabilities consistently meet regulatory requirements, client commitments, and evidence-based standards. As a subject matter expert in utilization management, this role actively supports delegated clinical operations, participates in new client implementations, evaluates emerging clinical needs, and ensures seamless integration between clinical operations and technology. The Manager executes clinical governance activities while contributing to innovation through hands-on automation testi [... source excerpt omitted ...] adoption of AI-enabled solutions. What you’ll do: Perform clinical reviews of our product, workflows, and programs to ensure they align with evidence-based practice, regulatory requirements, and client expectations Write and refine clinical requirements, user stories, and acceptance criteria for UM workflows, clinical decision support, and AI-enabled capabilities — and represent clinical integrity directly in sprint planning and design sessions with Product and Engineering Own operational readiness: run hands-on UAT, build test scripts and scenarios, document defects, and track readiness status for releases and client implementations Audit client commitments and SLAs against cu [... source excerpt omitted ...] playbooks, and training materials that keep clinical workflows consistent across all lines of business Partner cross-functionally with Clinical Operations, Product, Engineering, Client Success, Compliance, Legal, and Clinical Strategy as the day-to-day point of contact for clinical integrity Support business growth by contributing clinical assessments, RFP/RFI responses, and feasibility reviews for prospective clients What you’ll need: An RN, PT, OT, or SLP with an active, unrestricted clinical license and a Bachelor's degree in Nursing, Therapy, Healthcare Administration, or a related field 5+ years of progressive experience in Utilization Management, Clinical Operations
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