About the role
Cohere Health is hiring a full-time, fully remote RN to support its utilization management work with medical necessity reviews and member and provider correspondence. You'll prepare clinical determinations alongside Medical Directors and write compliant letters. Shifts are assigned across a seven-day, 8 AM–8 PM Eastern coverage window.
Responsibilities
- Consult with Medical Directors on clinical determinations and medical necessity decisions
- Prepare accurate, compliant member and provider letters
- Apply regulatory requirements to determinations and communications
- Know when written and verbal notifications are required and support verbal notification workflows
- Document clinical information completely and on time
- Meet productivity, quality, and turnaround targets
- Keep UM practices aligned with accreditation and regulatory standards
Requirements
- Active, unencumbered RN license in your state of residence
- Bachelor's degree in nursing
- At least 3 years of clinical experience
- UM or review experience, including writing member and provider correspondence in a health plan setting
- Knowledge of NCQA and CMS standards
- Schedule: 40 hours a week; the department is staffed seven days a week, 8 AM–8 PM Eastern, with shifts assigned by need
- Home internet above 50 Mbps and ability to use Zoom with video; proficiency with a Mac and G Suite
- About 5% travel
What we offer
- Medical, dental, vision, life, and disability insurance plus an EAP
- 401(k) with company match, FSA, and HSA
- Up to 184 hours (23 days) of PTO per year plus company holidays
- Up to 14 weeks of paid parental leave
- Bonus eligibility
- Pet insurance