What are the responsibilities and job description for the Medical Director, Clinical Policy position at Leading Age?

Company Overview :

Cohere Health is a fast-growing clinical intelligence company that’s improving lives at scale by promoting the best patient-specific care options, using leading edge AI combined with deep clinical expertise. In only four years our solutions have been adopted by health insurance plans covering over 15 million people, while our revenues and company size have quadrupled. That growth combined with capital raises totaling $106M positions us extremely well for continued success. Our awards include : 2023 and 2024 BuiltIn Best Place to Work, Top 5 LinkedIn Startup, TripleTree iAward, multiple KLAS Research Points of Light, along with recognition on Fierce Healthcare's Fierce 15 and CB Insights' Digital Health 150 lists.

Opportunity Overview :

We are looking for an experienced physician for the role of Medical Director, Healthcare Policy. This position will report to the Chief Medical Officer and will manage a team of medical writers, editors, and clinical policy specialists in the research, development and implementation of medical coverage policies for various lines of business and for multiple health plan clients. This role will include client facing responsibilities including review of health plan client policies and presentation of recommendations.

This physician role will have a direct impact on the lives of our clinicians and their patients. You’ll play a central role in creating, maintaining, and communicating our provider facing and policy content, as well as ensuring content is configured within our product to optimize the clinical review of medical services based on current evidence based medical literature and standards of care.

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 :

Editorial lead for clinical guidelines across various specialties
Manage the content pipeline / roadmap for clinical specialities
Create and enforce processes for developing, maintaining, and communicating medical policy and provider facing content.
Review, update, and document revisions to established medical policies and communicate to key stakeholders
Responsible for reporting on policy coverage across Cohere’s customers and specialty lines
Assist Clinical Content departmental heads in strategic development and expansion of medical policies and provider facing content
Scope new content development projects that will be delivered on time, meet all requirements, and be of the highest quality
Manage a team of Medical Writers, Editors, and Clinical Policy Specialists

Your background & requirements :

5 years in managed care or clinical strategy at a health plan, healthtech / solutions / services, topical consulting experience (partner-level), or a related payer-facing roles

Medical Degree required and advanced degree in healthcare-related discipline preferred

5 years of clinical practice beyond residency / fellowship preferred

5 years experience in clinical, regulatory, or scientific writing

Thorough understanding of scientific research

Experience serving as the lead thinker / consulting partner, designing innovative clinical programs and interventions driving value for payers and their members

Success in building credibility, influence and partner with key clients

Demonstrated ability to work collaboratively and influence internal partner groups

Strong communication and team management / interpersonal skills

Strong leadership capabilities and ability to initiate and maintain cross-team relationships

Prior experience with medical policy and content development

Knowledge of medical coding terminologies (HCPCs, CPT, ICD-10)

Working knowledge of Medicare (including NCDs / LCDs), Commercial and Medicaid medical policies

Experience in reviewing clinical literature in order to understand implications of policy changes

Strong oral and written communication skills and the ability to interact within all levels of the organization

Ability to maintain high-quality outputs by developing and enforcing organizational standards and efficiencies

Ability to work in a fast-paced environment

You are passionate about improving the U.S. healthcare system and helping ensure every patient receives the best care possible

You are self-directed, confident, and thrive working in a fast-paced startup environment

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.

The salary range for this position is $250,000.00 to $300,000.00; as part of a total benefits package which includes health insurance, 401k and bonus. 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.

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Salary : $250,000 - $300,000

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