Clinical Integrity Manager

The posting, as Cohere Health wrote it

Opportunity Overview

We are seeking a technology-savvy clinical leader with strong expertise in Utilization Management (UM) to join Cohere Health as the Manager, Clinical Integrity. Reporting to the Vice President, Clinical Integrity, this role is a hands-on operational leader responsible for directly executing and maintaining the integrity, scalability, and operational readiness of Cohere's clinical programs and technology-enabled solutions.

The Manager works alongside leaders across Clinical Operations, Product, Engineering, Clinical Programs, Client Success, Growth, Implementation, and Clinical Strategy to ensure that clinical integrity is embedded throughout the product lifecycle and operational execution. This leader directly translates enterprise clinical strategy into scalable processes, governance documentation, and day-to-day operational excellence while ensuring Cohere's clinical capabilities consistently meet regulatory requirements, client commitments, and evidence-based standards.

As a subject matter expert in utilization management, this role actively supports delegated clinical operations, participates in new client implementations, evaluates emerging clinical needs, and ensures seamless integration between clinical operations and technology. The Manager executes clinical governance activities while contributing to innovation through hands-on automation testing, workflow optimization, and responsible adoption of AI-enabled solutions.

What you’ll do

• 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

What you’ll need

• 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+ yea

[…]
’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.

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.

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