Clinical Process and Standards Director

We are seeking a Clinical Process and Standards Director to join our Clinical Operations team. In this role, you will work closely with the clinical operations leadership team at Cohere and report to the Sr. Director of Clinical Process and Standards. As part of the Clinical Operations organization, this role will support new implementation and change initiatives to ensure quality, consistency and scalability in a fast-paced, rapidly expanding environment.

This is an opportunity to make an impact on the way the clinical ops team members perform their roles by reducing unnecessary variation, simplifying and incorporating automation, and collaborating with the product team to leverage technology to support.

• →Lead clinical process improvement initiatives and new delegated client initiatives
• →Monitor performance and influence performance to client SLAs
• →Conduct root cause analyses, develop remediation plan development and lead remediation execution for process variation, including CAPs
• →Collaborate with product team and analytics team 
• →Understand current clinical operations processes deeply and assess performance to work instructions, P&Ps
• →Ensure processes are compliant with regulations and accreditation requirements, including through process mapping and work instruction development
• →Lead correspondence workflows
• →Identify and drive cost-savings initiatives 

• Bachelor's degree in healthcare and active clinical licensure in your state of residence (RN strongly preferred; PT/OT/SLP with a strong clinical background considered)
• 7+ years of leadership experience in healthcare operations, payer/provider communications, or utilization management
• Proven track record building new functions and creating operational structure in ambiguous, fast-paced environments
• Working knowledge of healthcare regulatory and accreditation requirements (CMS, NCQA, URAC)
• Strong process improvement, QA, and audit readiness experience, including policy/procedure and work instruction development
• Skilled with spreadsheets (Excel, Google Sheets) for data analysis and quantitative decision-making, and comfortable building decks (PPT, Google Slides)
• Experience with automation technologies, letter management systems, and workflow platforms; AI/ML exposure in utilization management a plus
• Ability to translate complex business requirements into clear, actionable specs for technical and operational teams
• Exceptional communication and stakeholder management skills, with the ability to influence without direct authority
• Independent, outcomes-oriented problem solver comfortable driving change in ambiguous environments
• Master's degree, Lean Six Sigma certification, or inpatient utilization management experience a plus

1. Connect with Talent Acquisition for a Preliminary Phone Screening
2. Meet your Hiring Manager!
3. Behavioral Interview(s)

*Subject to change

Cohere Health’s clinical intelligence platform and agentic AI-powered solutions connect health plans’ strategic goals and providers’ needs, optimizing the speed, cost, and quality of care. With an enterprise approach that streamlines payer-provider decision-making across the care continuum–including policy, prior authorization, payment accuracy, and more–the company improves collaboration and reduces burden, resulting in up to 8x ROI and 94% provider satisfaction. 

With the acquisition of ZignaAI, we’ve further enhanced our platform by launching our Payment Integrity Suite, anchored by Cohere Validate™, an AI-driven clinical and coding validation solution that operates in near real-time. By unifying pre-service authorization data with post-service claims validation, we’re creating a transparent healthcare ecosystem that reduces waste, improves payer-provider collaboration and patient outcomes, and ensures providers are paid promptly and accurately.

Cohere Health’s innovations continue to receive industry wide recognition. We’ve been named to the 2025 Inc. 5000 list and in the Gartner® Hype Cycle™ for U.S. Healthcare Payers (2022-2025), and ranked as a Top 5 LinkedIn™ Startup for 2023 & 2024. Backed by leading investors such as Deerfield Management, Define Ventures, Flare Capital Partners, Longitude Capital, and Polaris Partners. 

The Coherenauts, as we call ourselves, 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.

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.

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