Clinical Reviewer, OT

About this role

Opportunity Overview:

We are looking for a licensed Occupational Therapist (OT) who has expertise in occupational therapy to deliver on Cohere’s therapy programs by determining the medical appropriateness of services by reviewing clinical information and applying evidence-based guidelines.

Reporting to a Managing Medical Director, and part of the review team that includes non-clinical intake specialists and nurses. This is a fast-paced environment that favors people who are able to learn quickly, be hands-on, handle ambiguity, and communicate effectively with people of different backgrounds and perspectives.

What you’ll do:

• Provide timely medical reviews that meet Cohere’s stringent quality parameters

• Provide clinical determinations based on evidence-based criteria while utilizing clinical acumen

• Clearly and accurately document all communication and decision-making in Cohere workflow tools, ensuring a member and provider can easily reference and understand your decision

• Use correct templates for documenting decisions during case review

• Meet the appropriate turn-around times for clinical reviews

• Conduct timely peer-to-peer discussions with treating providers to clarify clinical information and to explain review outcome decisions, including feedback on alternate treatment based on medical necessity criteria and evidence-based research

• Demonstrate the highest level of professionalism, accountability, and service in your interactions with Cohere teammates and providers

• Support projects specific to building the team's clinical expertise and efficiency, as delegated

• Support the team on operational improvements and member/provider experience involving clinical review tasks, as delegated

What you’ll need:

• Master’s degree in Occupational Therapy from an accredited program

• Active, unrestricted Occupational Therapist license in the state of practice

• 5 or more years of direct clinical patient care experience

• Familiarity with facilities rendering care in PT, OT, SLP

• 1+ years of managed care utilization review experience, preferably in an utilization management organization within a Medicare, Commercial or Medicaid payor organization preferred

Pay & Perks:

💻 Fully remote opportunity with about x% travel

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

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

🏝️ Flex Time Off + company holidays

👶 Up to 14 weeks of paid parental leave

🐶 Pet insurance 

The salary range for this position is $95,000 to $105,000 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.

Interview Process*:

• Connect with Talent Acquisition for a Preliminary Phone Screening

• Meet your Hiring Manager!

• Behavioral Interview(s)

*Subject to change

About Cohere Health:

Cohere Health’s clinical intelligence platform and agentic AI-powered solutions connect health plans’ strategic goals and providers’ needs, optimizing the speed, cost, and quality of care. With an enterprise approach that streamlines payer-provider decision-making across the care continuum–including policy, prior authorization, payment accuracy, and more–the company improves collaboration and reduces burden, resulting in up to 8x ROI and 94% provider satisfaction.

With the acquisition of ZignaAI, we’ve further enhanced our platform by launching our 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 transparent healthcare ecosystem that reduces waste, improves payer-provider collaboration and patient outcomes, and ensures providers are paid promptly and accurately.

Cohere Health’s innovations continue to receive industry wide recognition. We’ve been named to the 2025 Inc. 5000 list and in the Gartner® Hype Cycle™ for U.S. Healthcare Payers (2022-2025), and ranked 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.

The Coherenauts, as we call ourselves, 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.

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.

#LI-Remote

#BI-Remote

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