Cohere Health · 6 hours ago
RN Reviewer
United States
Full-time
Hybrid
Mid Level
$33/hr - $35/hr
3+ years expCohere Health is a company focused on improving payer-provider collaboration in healthcare through AI-powered solutions. The RN Reviewer will be responsible for reviewing clinical requests to determine medical appropriateness and collaborating with Medical Directors to ensure cost-effective care.
Consumer SoftwareHealth CareSaaSSoftware
Responsibilities
Review medical necessity for inpatient, concurrent, prior auth, and retrospective cases to ensure appropriate, high-quality care
Collaborate with Medical Directors and providers to align on clinical decisions
Document reviews accurately and meet production/quality goals
Apply MCG, Cohere, and coverage guidelines to ensure compliance and consistency
Partner across teams (Operations, Product, Quality, Health Plans) to improve processes and outcomes
Identify opportunities for care management or quality improvement programs
Support accreditation, regulatory, and quality initiatives
Qualification
Required
Active, unencumbered RN license (state of residence)
3+ years of clinical experience
Utilization Management experience
Experience in acute or post-acute settings
Comfortable using Mac and Google Workspace
Strong communication skills and continuous improvement mindset
Strong communication and collaboration skills across remote teams
Customer-focused mindset and ability to stay calm under pressure
Adaptability in a fast-moving, startup environment
Solid understanding of utilization and case management programs
Organized, detail-oriented, and comfortable managing multiple priorities
Knowledge of NCQA/CMS standards; proficiency with MCG (CareWebQI a plus)
Preferred
HEDIS abstraction
Legal RN
Utilization Review background
Bachelor's degree in Nursing, Business, or related field
Benefits
Medical, dental, vision, life, disability insurance, and Employee Assistance Program
401K retirement plan with company match; flexible spending and health savings account
Up to 184 hours (23 days) of PTO per year + company holidays
Up to 14 weeks of paid parental leave
Pet insurance
Company
Cohere Health
Cohere Health is a SaaS company that focuses on improving the efficiency and effectiveness of healthcare delivery.
501-1000 employees
Funding
Current Stage
Late StageTotal Funding
$186.1MKey Investors
Temasek HoldingsDeerfield ManagementPolaris Partners
2025-05-14Series C· $90M
2024-02-01Series C· $50M
2021-04-13Series B· $36.1M
Leadership Team
Siva Namasivayam
Chief Executive Officer
Robert Shepardson
Chief Financial Officer
Recent News
Company data provided by crunchbase