Company Overview:
Cohere Health is a fast-growing clinical intelligence company thats improving lives at scale by promoting the best patient-specific care options, using cutting-edge AI combined with deep clinical expertise. In only four years our solutions have been adopted by health plans covering over 15 million lives, 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 awards, along with recognition on Fierce Healthcare's Fierce 15 and CB Insights' Digital Health 150 lists.
Opportunity Overview:
This role will be primarily responsible for researching, analyzing, and providing guidance on federal and state regulations, as well as NCQA and URAC standards. This role will also assist with development and enhancement of the Cohere compliance program.
The Sr. Regulatory Compliance Manager will research laws and regulation in response to questions from internal and external stakeholders, and in conjunction with other members of the compliance and quality team. The Sr. Regulatory Compliance Manager will also collaborate on projects to ensure Coheres compliance program meets standards established by federal law, such as risk assessment, monitoring and auditing, communications and training.
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:
- Maintains a strong working knowledge of state and federal legislation, statutes and regulations for health care and health insurance.
- Ensures compliance by reviewing, operating practices, systems, and documentation against regulatory standards; will provide recommendations for improvement and coaching as necessary.
- Provides regulatory compliance guidance to all levels of leadership.
- Responds to compliance inquiries from internal and external stakeholders.
- Leads Coheres Legislative Implementation process.
- Partners with the Chief Compliance Officer on developing the regulatory affairs function.
- Participates in projects to enhance Cohere Healths compliance program, such as compliance risk assessment, and monitoring and auditing.
- Other tasks as assigned by the CCO.
Your background & requirements:
- Bachelors degree or equivalent relevant experience in health insurance
- Minimum 6+ years in healthcare compliance, preferably in Utilization Management or other health plan role
- Experience in Medicare/Medicaid and HIPAA Privacy preferred
- Understanding of compliance program development
- Certification in Healthcare Compliance (CHC) a plus
We cant 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, its personal.
The salary range for this position is $130,000 to $160,000 annually; 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.
