Senior Inpatient UM Nurse Auditor (CONTRACT)

Key Skills

Aartificial intelligence, Effective communication skills, Machine learning techniques

Job Description

Opportunity Overview:

You will play a foundational role in the development of an industry-leading solution that harnesses clinical expertise and AI / ML to enhance acute inpatient utilization management clinical review quality and efficiency. You will apply your clinical expertise to audit acute inpatient authorizations to validate the appropriate level of care, synthesize audit patterns, and help design automation algorithms.

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:

• Audit acute inpatient authorizations for unplanned admissions (including authorization data, clinical records, evidence-based guidelines, and nurse clinical review documentation) to validate the appropriate level of care, with a keen focus on quality
• Synthesize patterns across audits and identify opportunities for clinical review automation
• Help build presentations summarizing audit results for internal and external communication
• Collaborate with cross-functional teams to develop clinical review automation algorithms
• Help evaluate performance of clinical review automation algorithms

Your background & requirements:

• Registered Nurse (RN), associate or bachelor’s degree
• Top performer with 10+ years of experience conducting payer utilization management clinical reviews or audits for acute inpatient authorizations for unplanned admissions
• Deep understanding of payer end-to-end acute inpatient authorization processes, including policies and procedures (e.g., CMS 2 midnight rule, MCG / Interqual guidelines)
• Independent, objective thinker that doesn’t just take things at face value
• Extremely diligent with an absolute focus on quality
• Adept at analyzing data to help solve problems
• Values simplicity; adept at distilling complex clinical concepts into comprehensive, clear, and actionable frameworks
• Passion for and conceptual understanding of how AI / ML can be used to optimize UM
• Natural inclination to look for ways to improve the status quo
• Proficient in key applications (e.g., clinical review apps, spreadsheets, document processors)

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.

This is a temporary contract position and the pay rate for this position is $50 to $60 per hour. 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.