Teams at Cohere Health

Physician role performing evidence-based utilization reviews and clinical determinations for medical appropriateness. Review and refine clinical decision guidelines, document decisions in workflow tools, conduct peer-to-peer discussions with treating providers, and support clinical content, operational improvements, and team efficiency. Maintain required medical credentials and comply with managed care regulatory expectations.

Perform utilization management medical necessity reviews, draft compliant member and provider correspondence, consult with Medical Directors, ensure regulatory and accreditation compliance (NCQA/CMS), document determinations, meet productivity and turnaround goals, and support verbal notification workflows for timely clinical communication.

Perform evidence-based utilization management reviews, prepare compliant member and provider correspondence, consult with Medical Directors, document clinical determinations, ensure NCQA/CMS regulatory compliance, meet productivity and turnaround targets, support verbal notifications, and drive process improvements.