[Remote] Clinical Integrity Manager

Note: The job is a remote job and is open to candidates in USA. Cohere Health is seeking a Manager, Clinical Integrity to maintain the integrity, scalability, and operational readiness of its clinical programs and technology-enabled solutions. The role translates clinical strategy into scalable processes and governance, supports delegated utilization management operations and client implementations, and partners across teams to ensure regulatory compliance and evidence-based execution.

Responsibilities

• Perform clinical reviews of our product, workflows, and programs to ensure they align with evidence-based practice, regulatory requirements, and client expectations
• Write and refine clinical requirements, user stories, and acceptance criteria for UM workflows, clinical decision support, and AI-enabled capabilities — and represent clinical integrity directly in sprint planning and design sessions with Product and Engineering
• Own operational readiness: run hands-on UAT, build test scripts and scenarios, document defects, and track readiness status for releases and client implementations
• Audit client commitments and SLAs against current product capabilities, flag gaps, and drive remediation
• Build and maintain governance documentation, SOPs, playbooks, and training materials that keep clinical workflows consistent across all lines of business
• Partner cross-functionally with Clinical Operations, Product, Engineering, Client Success, Compliance, Legal, and Clinical Strategy as the day-to-day point of contact for clinical integrity
• Support business growth by contributing clinical assessments, RFP/RFI responses, and feasibility reviews for prospective clients

Skills

• An RN, PT, OT, or SLP with an active, unrestricted clinical license and a Bachelor's degree in Nursing, Therapy, Healthcare Administration, or a related field
• 5+ years of progressive experience in Utilization Management, Clinical Operations, or health plan operations, including 2+ years in a leadership or supervisory capacity
• Strong knowledge of Medicare Advantage, Medicaid, Commercial, and Marketplace UM, along with CMS regulations, NCQA accreditation, and delegation oversight
• Experienced partnering with Product and Technology teams to shape clinical workflows and digital solutions — you've influenced what gets built, not just used what was handed to you
• Comfortable with hands-on execution: writing documentation, testing workflows, building process tools, and managing the details
• A strong communicator who can build trust and influence stakeholders across functions without formal authority
• A Master's degree
• Experience with AI-enabled clinical workflows
• Familiarity with InterQual® or MCG®
• A Lean/Six Sigma/Agile/PM certification
• Prior UAT/QA experience in a tech environment

Benefits

• Fully remote opportunity with about 10% travel
• Medical, dental, vision, life, and disability insurance, and Employee Assistance Program
• 401K retirement plan with company match
• Flexible spending and health savings account
• Flex Time Off + company holidays
• Up to 14 weeks of paid parental leave
• Pet insurance
• Bonus

Company Overview

Company H1B Sponsorship