Clinical Integrity Manager

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.

• 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

• 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+ years in a leadership or supervisory capacity

• Strong knowledge of Medicare Advantage, Medicaid, Commercial, and Marketplace UM, along with CMS regulations, NCQA accreditation, and delegation oversight

• Experienced partnering with Product and Technology teams to shape clinical workflows and digital solutions — you've influenced what gets built, not just used what was handed to you

• Comfortable with hands-on execution: writing documentation, testing workflows, building process tools, and managing the details

• A strong communicator who can build trust and influence stakeholders across functions without formal authority

• Bonus points for a Master's degree, experience with AI-enabled clinical workflows, familiarity with InterQual® or MCG®, a Lean/Six Sigma/Agile/PM certification, or prior