Company Overview:
Cohere Health is a fast-growing clinical intelligence company that's improving lives at scale by promoting the best patient-specific care options, using leading edge AI combined with deep clinical expertise. In only four years our solutions have been adopted by health insurance plans covering over 15 million people, while our revenues and company size have quadrupled. That growth combined with capital raises totaling $106M positions us extremely well for continued success. Our awards include: 2023 and 2024 BuiltIn Best Place to Work, Top 5 LinkedIn™ Startup, TripleTree iAward, multiple KLAS Research Points of Light, along with recognition on Fierce Healthcare's Fierce 15 and CB Insights' Digital Health 150 lists.
Opportunity Overview:
This role will be primarily responsible for performing clinical compliance and quality audits to ensure compliance with federal and state regulations, NCQA, URAC and client contractual requirements. This role will also assist with data collection, analysis and reporting for process improvement efforts.
The Compliance Quality Auditor will plan, coordinate, and conduct compliance audits at the direction of the Manager of Compliance and Audit, Director of Compliance Quality, Compliance Officer and Quality Committee. Scope includes reviewing / auditing of all CMS required data tables, utilization management processing / determinations and associated clinical rationale against applicable rules and regs. Will also include quality assurance functions and quality improvement. Cross-functional role with responsibilities in compliance auditing and quality improvement.
Last but not least: People 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.
What you will do:
- Ensures compliance with regulations by examining and analyzing records, reports, operating practices, and documentation; will provide recommendations for improvement and coaching as necessary
- Completes audit work papers and memorandums by documenting audit findings
- Presents audit findings to the Quality Committee or other leadership body
- Maintains excellent documentation of all audits, methodologies employed, results, corrective action plans implemented, and monitoring
- Communicates audit progress and findings by preparing reports, discussions with management and providing information in meetings
- Analyzes quality assurance and compliance data and assists in preparing reports.
- Assists in designing and implementing solutions to quality management issues.
- Maintains a strong working knowledge of state and federal legislation, statutes and regulations, as well as various client service level agreements
- Other tasks as assigned by the Compliance Officer
Your background & requirements:
- Completion of an accredited Registered Nursing Program (bachelor's degree or higher degree required)
- Certification in Healthcare Compliance (CHC) Preferred or willingness to achieve certification within 12 months of employment
- Minimum 2 years in a healthcare auditing or operations role, preferably in Utilization Management clinical review/case management
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.
The salary range for this position is $60,000 to $80,000 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.
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