Clinical Training & Quality Specialist

Cohere Health provides clinical intelligence solutions that improve healthcare access, payer-provider collaboration, and care quality. The Clinical Quality and Training Specialist will implement clinical quality measurements, analyze performance data, deliver coaching and training, maintain operational materials, and support workflow changes across Clinical Operations.

Responsibilities

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

Preferred

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

Quality Management Systems

QA Audits

Adult Learning Theory

Coaching

Constructive Feedback

Benefits

Fully remote opportunity with about 5% travel

Medical, dental, vision, life, disability insurance, and Employee Assistance Program

401K retirement plan with company match; flexible spending and health savings account

Flexible Time Off + Company Holidays

Up to 14 weeks of paid parental leave

Pet insurance

Company

AI-powered prior authorization and payment integrity for health plans

Boston, Massachusetts, USA

https://coherehealth.com/

Founded in 2019

501-1000 employees

Qualifications

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

About 5% travel

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

Required skills

Active RN Licensure, Healthcare Coverage Determinations, NCQA and CMS Utilization Management Standards, LCD/NCD Coverage Determination, Adult Learning Theory, Data Collection and Analysis, Google Sheets, Google Docs, Google Forms, Coaching

Preferred skills

Written and Verbal Communication

Experience

2+ years