Clinical Training & Quality Specialist

We are seeking a Clinical Quality and Training Specialist to join our Training and Quality team. In this role, you will implement clinical quality measurements, scoring, and performance improvement data designed to improve operational efficiency while exceeding industry standards for quality performance and clinical guidance. You will apply subject-matter expertise to guide and support the training and quality needs of Clinical Operations. This includes building the success of the company through clinical training and development. With a solid foundation in quality analysis, feedback, instructing/coaching; you are expected to be flexible and nimble in your role to manage short- and long-term projects as well as dealing with day-to-day QA tasks. Cohere culture is one of partnership and ownership.

• Audit Individual Operations team members on Clinical decisions against clinical guidelines

• Translate QA findings into clear insights and recommendations for operational leaders and cross-functional partners.

• Develop and deploy structured coaching sessions based on audit findings to improve accuracy, decision-making, and skill development.

• Create and ensure accuracy of SOPs, job aids, workflow guides, and new product readiness materials.

• Facilitate onboarding and ongoing upskilling sessions for Clinical teams using adult learning principles and SME feedback.

• Lead QA/Training side of project implementations by operationalizing workflow changes, quality expectations, and training updates into the business.

• Partner with Product, Clinical, Client Services, and Operations to validate workflow changes and identify potential quality or compliance risks.

• Support change management by communicating process updates and aligning QA expectations across impacted teams.

• Serve as a subject matter expert and advisor to frontline leaders on quality trends, training needs, and operational readiness.

• Manage multiple concurrent priorities with independence, ownership, and accountability for deliverables, exercise discretion and independent judgment.

• Step into operational queues to maintain service levels and ensure continuity of operations, as needed during high-volume periods.

• Coach team members for improvement against quality metrics

• Provide reporting on performance and key areas of quality improvement to Sr Leadership

• Other duties as assigned

• Active RN Licensure

• 2+ years experience in the process of Coverage Determinations in Healthcare

• NCQA and CMS standards for Utilization Management Authorization decisions

• LCD/NCD Coverage Determination Ability to conduct effective coaching sessions

• Understanding of Adult Learning Theory and Training RN

• Attention to detail, Communication skills - verbal and written

• Data collection, management and analysis

• Problem analysis and problem solving, Planning and organizing, Effective interaction with stakeholders

• Experience in the process of Coverage Determinations in Healthcare

• Proficiency with Google Workspace (Sheets, Docs, Forms); ability to build pivot tables and create charts or dashboards is a plus

• Experience identifying performance trends and root causes through data is a plus

• Experience using quality management systems and conducting structured QA audits is a plus

• Experience facilitating coaching sessions and giving constructive feedback is a ples

• Understanding of Adult Learning Theory and Training is a plus

💻 Fully remote opportunity with about 5% travel

🩺 Medical, dental, vision, life, disability