About the job
Cohere Health is on the lookout for skilled physicians with a deep understanding of Cardiology and Vascular medical topics to spearhead our innovative Cardiology program. In this role, you will assess the medical appropriateness of services by reviewing clinical information and applying evidence-based guidelines.
As a key member of our team reporting directly to the Medical Director of Cardiology, you will play a pivotal role in a rapidly growing organization dedicated to enhancing the health of millions of patients. We thrive in a dynamic environment that rewards quick learners, hands-on contributors, and effective communicators from diverse backgrounds.
Your Responsibilities:
- Collaborate with the clinical development team to evaluate and refine the company’s clinical decision guidelines and evidence-based literature.
- Provide expert insights on content and initiatives aimed at influencing physicians in cardiovascular care to enhance the quality of patient outcomes.
- Conduct timely medical reviews in line with Cohere’s high standards for quality and timeliness.
- Utilize your clinical expertise to make evidence-based clinical determinations.
- Document all communications and decision-making processes clearly and accurately in Cohere workflow tools, ensuring clarity for both members and providers.
- Follow established templates for decision documentation during case reviews.
- Engage in peer-to-peer discussions with treating providers to clarify clinical information and explain review outcomes, including feedback on alternative treatments based on medical necessity criteria and evidence-based research.
- Exhibit the highest standards of professionalism, accountability, and service in your interactions with Cohere colleagues and providers.
- Assist in projects aimed at building the team’s clinical expertise and efficiency, as assigned.
- Contribute to operational improvements and enhance member/provider experiences related to clinical review tasks, as needed.
Qualifications:
- U. S.-based residency in Internal Medicine complemented by a fellowship in Cardiology.
- Board certification (MD or DO) with an active, unrestricted state medical license; all required credentials must be maintained.
- A minimum of 5 years of clinical practice beyond residency/fellowship in Internal Medicine or Cardiology.
- At least 1 year of managed care utilization review experience is preferred.
- Membership in national and/or regional specialty societies is a plus.
- Licensure in FL, MN, and other states is beneficial.
