Cohere Health is illuminating healthcare for patients, their doctors, and all those who are important in a patient’s healthcare experience, both in and out of the doctors office. Founded in August, 2019, we are obsessed with eliminating wasteful friction patients and doctors experience in areas that have nothing to do with health and treatment, particularly for diagnoses that require expensive procedures or medications. To that end, we build software that is expressly designed to ensure the appropriate plan of care is understood and expeditiously approved, so that patients and doctors can focus on health, rather than payment or administrative hassles.
We are looking for a Nurse Writer who will support how this department develops policy and patient content.
This role is responsible for creating and maintaining letter templates that meet regulatory, Health Plan and Plain Language requirements for adverse determination decisions. This position requires a person who can synthesize various clinical and administrative requirements, communicate well with the team and clients, and write clearly.
What you will do:
- Create adverse determination notifications that meet all accreditation, State, and Federal criteria and all Health Plan requirements
- Use Plain Language and good written skills to clearly communicate adverse decisions to both members and providers
- Work with internal and external staff to ensure that decisions are made, documented and communicated clearly
- Appropriately identify and refer quality issues to the Medical Director and Compliance
- Maintain denial language letter templates in accordance with all requirements
- Create a data repository that is maintained and updated as needed with new denial letter templates
- Partner with other members of the clinical product team (informatics, clinical content, designers, etc.) to capture, structure, and automate clinical knowledge
- Become our internal expert on everything clinical, including Cohere’s unique approach for capturing clinical guidelines and patient facing content and embedding them into Cohere’s product
Your background and characteristics:
- Excellent clinical writing and editing skills
- Detail oriented
- Ability to translate clinical terminology into patient facing content
- Knowledge of Plain Language requirements
- Knowledge of managed care principles, HMO and Risk Contracting arrangements.
- Experience with clinical decision-making criteria sets (i.e. Milliman, InterQual)
- Strong interpersonal, oral and written communication skills.
- Competent on a computer, proficient in google applications (ie; sheets, slides, docs, etc)
- Proficient in using a Mac laptop computer, Microsoft Excel and Microsoft Word
- 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
- Licensed registered nurse (current and unrestricted)
- Minimum of one year of experience with prior authorization activities in a utilization management organization, experienced in writing policies or patient facing content (preferred)
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.