Cohere Health

Compensation

Full Description

Cohere is looking for a Director of Utilization Management Communications to lead the establishment of a new cross-functional capability dedicated to the seamless management of provider and member review communications. This role encompasses the development, standardization, automation, and quality assurance of all related communications (including fax, email, letters, phone, VAT) across various lines of business. As this is a new function, the Director will play a dual role as both architect and operator, creating structure where ambiguity currently exists. You will define governance frameworks, establish key metrics, and design effective workflows, all while fostering strong relationships within Compliance, Clinical, Technical Services, Product, and Client Success teams. This position will offer both strategic vision for communications governance and automation, alongside managing operational details to ensure accuracy, compliance, and efficiency. Strategy & Leadership: • Establish and guide the Review Communications function, outlining vision, structure, and standards. • Construct clear governance frameworks to maintain consistent tone, language, and quality in communications. • Identify and implement opportunities for automation and enhanced efficiency in communication workflows. • Provide strategic direction and alignment among key teams engaged in the communication processes. Cross-functional Collaboration: • Translate business needs into explicit requirements for communication templates, workflows, and tools. • Collaborate with Product, Technical Services, Clinical, Compliance, and Vendor teams to ensure the delivery of accurate, compliant, and scalable communication solutions. • Work closely with Client Success to address escalations and guarantee high levels of client satisfaction. Execution & Oversight: • Oversee the complete process for creating, testing, approving, and deploying communications. • Establish and uphold quality assurance standards to ensure accuracy, audit readiness, and consistency. • Monitor performance, vendor outcomes, and key quality metrics to foster continuous improvement. • Mentor team members and partners to promote transparency, accountability, and high-quality execution. What You'll Need: • 7+ years of experience in healthcare operations, payer/provider communications, or utilization management. • 5+ years in a leadership role managing multi-disciplinary or matrixed teams. • Proven ability to build new functions and develop operational structures within ambiguous environments. • Understanding of healthcare regulatory and accreditation requirements (CMS, NCQA, URAC). • Strong capability to translate complex business requirements into clear, actionable specifications for technical and operational teams. • Experience with automation technologies, letter management systems, and workflow platforms. • Outstanding communication and stakeholder management skills; adept at influencing without direct authority. • Demonstrated success in process improvement, quality assurance, and audit readiness. • Master's degree in healthcare administration, business, or a related field preferred. Pay & Perks: This is a fully remote opportunity with approximately 10% travel. Benefits include medical, dental, vision, life, and disability insurance, plus an Employee Assistance Program. We also offer a 401K plan with company match, flexible spending, and health savings accounts, along with up to 184 hours (23 days) of paid time off each year plus company holidays, parental leave of up to 14 weeks, and pet insurance. The salary range for this position is $150,000 to $165,000 annually, as part of a total compensation package that includes health insurance, 401K, and bonus opportunities. Cohere must adhere to state laws that require providing a reasonable estimate of the compensation range for this role, and individual pay decisions will consider qualifications, experience level, skillset, and internal alignment. Interview Process: • Connect with Talent Acquisition for a Preliminary Phone Screening. • Meet your Hiring Manager. • Participate in a Behavioral Interview. • Undergo an Executive Interview. About Cohere Health: Cohere Health's clinical intelligence platform offers AI-powered solutions designed to optimize access to quality care by enhancing payer-provider collaboration, cost containment, and healthcare economics. Over 660,000 providers work with us, processing more than 12 million prior authorization requests annually. Our responsible AI system auto-approves up to 90% of requests for millions of health plan members. With the acquisition of ZignaAI, we've enhanced our platform by launching the 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 more transparent healthcare ecosystem that reduces waste, enhances payer-provider collaboration, and improves patient outcomes. Cohere Health has received industry-wide recognition for its innovations, including being listed in the 2025 Inc. 5000 list and in the Gartner Hype Cycle for U.S. Healthcare Payers (2022-2025), as well as ranking 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, Cohere Health is dedicated to driving more transparent, streamlined healthcare processes that ensure patients receive faster, more appropriate care and improved outcomes. Our team, known as Coherenauts, is made up of empathetic individuals who prioritize kindness and embody our core values and principles. We believe that diverse, inclusive teams create the most impactful work. Cohere is committed to providing a supportive, growth-oriented environment that works for everyone. Equal Opportunity Statement: Cohere Health is an Equal Opportunity Employer. We are devoted to creating an environment of mutual respect with equal employment opportunities for all. To us, it's personal.