Medical Director Therapy

Overview

Medical Director for Therapy reviewing medical necessity of therapy services (PT/OT/SLP) by applying clinical judgment and evidence-based guidelines. Reports to the Managing Medical Director for Cohere Health.

What you'll do

• Support the clinical content team in reviewing the company's clinical decision guidelines and evidence-based literature.
• Provide expert input on content for influencing physicians in medical care to improve the quality of patient outcomes.
• Provide timely medical reviews that meet Cohere's stringent quality and timeliness parameters.
• Provide clinical determinations based on evidence-based criteria while utilizing clinical acumen and knowledge of evidence-based literature and medical society guidelines.
• Clearly and accurately document all communication and decision-making in Cohere workflow tools, so a member and provider can easily reference and understand your decision.
• Use correct templates for documenting medical necessity decisions during case review.
• Conduct timely peer-to-peer discussions with treating providers to clarify clinical information and explain review outcome decisions, including feedback on alternate treatment based on medical necessity criteria and evidence-based research.
• Demonstrate the highest level of professionalism, accountability, and service in interactions with Cohere teammates and providers.
• Support projects specific to building the team's clinical expertise and efficiency, as delegated.
• Support the team on operational improvements and member/provider experience involving clinical review tasks, as delegated.

What you'll need

• Completed US-based residency program in PM&R, Family Practice, Pediatrics, or Internal Medicine.
• Board certification as an MD or DO with a current unrestricted state license to practice medicine; reviewers must maintain necessary credentials to retain the position.
• 5+ years of clinical practice beyond residency/fellowship in the above specialties.
• Understanding of Therapy programs (PT / OT / SLP) on outpatient and inpatient basis.
• Excels in a matrix organization.
• Comfortable with technology; willing and able to learn new software tools.
• Understanding of managed care regulatory structure and processes.
• Detail-oriented, flexible, and able to work autonomously with little supervision.

Nice to have

• 1+ years of managed care utilization review experience in Therapy (PT/OT/SLP).
• Licensure in AR, MO, MN, NC, IN, TX, NE; willing to obtain additional state licenses with Cohere's support.

Details

• Fully remote opportunity with about 5% travel.
• Salary range $210,000 - $260,000 annually, as part of a total benefits package including health insurance, 401k and bonus.
• Interview process: Talent Acquisition preliminary phone screen, meet the Hiring Manager, behavioral interview(s); subject to change.