Opportunity Overview: The RN Reviewer position is a crucial role in our organization — in this role you are responsible for performing a full range of activities that will positively impact the organization and contribute to guiding the strategic operations for the company. As an RN Reviewer, you will perform prospective review (prior authorization) admission, concurrent, and retrospective reviews according to established criteria and protocols to determine the medical appropriateness of the clinical requests from providers. You will work closely with Medical Directors and other Cohere Health staff to ensure appropriate cost-effective care by applying your clinical knowledge and critical thinking skills to assess the medical necessity of inpatient admissions, outpatient services and procedures, and provider out of network requests. You will be required to review Commercial, Medicare, and Medicaid lines of business. You will need to be an agile and comprehensive thinker and planner and be able to work in an environment that is in flux. This position offers the ability to make a substantive mark in simplifying the way healthcare is delivered and contributes to an up and coming company with exponential growth opportunity. What you'll do: - Review medical necessity for inpatient, concurrent, prior auth, and retrospective cases to ensure appropriate, high-quality care - Collaborate with Medical Directors and providers to align on clinical decisions - Document reviews accurately and meet production/quality goals - Apply MCG, Cohere, and coverage guidelines to ensure compliance and consistency - Partner across teams (Operations, Product, Quality, Health Plans) to improve processes and outcomes - Identify opportunities for care management or quality improvement programs - Support accreditation, regulatory, and quality initiatives What you'll need: - Strong communication and collaboration skills across remote teams - Customer-focused mindset and ability to stay calm under pressure - Adaptability in a fast-moving, startup environment - Solid understanding of utilization and case management programs - Organized, detail-oriented, and comfortable managing multiple priorities - Knowledge of NCQA/CMS standards; proficiency with MCG (CareWebQI a plus) Must Haves: - Active, unencumbered RN license (state of residence) - 3+ years of clinical experience - Utilization Management experience - Experience in acute or post-acute settings - Comfortable using Mac and Google Workspace - Strong communication skills and continuous improvement mindset - Preferred: HEDIS abstraction, Legal RN, or Utilization Review background - Bachelor’s degree in Nursing, Business, or related field Important to know about this role: - This is a 100% remote role, and requires robust internet speeds (above 50 megabytes/second), including the ability to utilize zoom meeting software and to stream video - The department is staffed seven days per week, 8am-8pm EST and shifts will be assigned based on need - This is a full time, 40 hour per week opportunity Pay & Perks: 💻 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 🏝️ Up to 184 hours (23 days) of PTO per year + company holidays 👶 Up to 14 weeks of paid parental leave 🐶 Pet insurance  The salary range for this position is $33 per hour to $35 per hour; 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*: - Internet Speed Test - Behavioral Interview(s) with your Hiring Manager! *Subject to change About Cohere Health: Cohere Health’s clinical intelligence platform delivers AI-powered solutions that streamline access to quality care by improving payer-provider collaboration, cost containment, and healthcare economics. Cohere Health works with over 660,000 providers and handles over 12 million prior authorization requests annually. Its responsible AI auto-approves up to 90% of requests for millions of health plan members. 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, Cohere Health drives more transparent, streamlined healthcare processes, helping patients receive faster, more appropriate care and higher-quality outcomes. 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

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Remote Role: Arizona License Required Working knowledge of psychological tests and testing procedures, diagnostic evaluations and evidence-based practices required. Prefer candidates located in the following time zones: AZ, CST, MST or PST Position Purpose: Authorize, direct and monitor care for behavioral health and/or substance abuse problems according to clinical information given by providers and internal criteria for medical necessity and appropriateness of care - Conduct peer reviews with psychologists, behavioral health therapists and/or Board Certified Behavior Analysts for outpatient services and/or psychological testing requests - Interact with network practitioners to provide education on best practice models and utilization management processes - Interact with the Medical Director, or designee, to discuss clinical authorization questions and concerns regarding specific cases - Respond to state, provider, and member complaints related to psychological testing or other services requiring review by a PhD/PsyD - Facilitate outpatient rounds offering clinical input and oversight related to outpatient services - Performs other duties as assigned - Complies with all policies and standards Education/Experience: PhD Clinical Psychology, Counseling, Behavior Analysis, or related field required : 2+ years Behavioral Health required Working knowledge of psychological tests and testing procedures, diagnostic evaluations and evidence-based practices. required For ABA Reviewers only, working knowledge of psychological tests and testing procedures, diagnostic evaluations and evidence-based practices designed for individuals with Autism Spectrum Disorder. required Licenses/Certifications: PSY - Psychologist Unrestricted License (PhD or PsyD) Upon Hire required Board Certified Behavior Analyst (BCBA) BCBA-D Upon Hire preferred Pay Range: $87,700.00 - $157,800.00 per year Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

• Conduct pre- and post-payment medical reviews to ensure compliance with clinical criteria and guidelines • Review medically complex claims, pre-authorization requests, appeals, and fraud/abuse referrals • Assess payment determinations using clinical information and established guidelines • Evaluate medical necessity, appropriateness, and reasonableness for coverage and reimbursement • Provide clear, well-documented rationales for service approvals or denials • Educate internal and external teams on medical review processes, coverage determinations, and coding requirements • Support quality control activities to meet corporate and team objectives • Assist with special projects and additional responsibilities as assigned

Role Description iMPROve Health is seeking a bariatric surgeon to serve as an independent contractor (1099) performing independent external medical reviews remotely on an ad hoc basis. As a peer reviewer, you will apply your clinical expertise to evaluate cases, specific to your specialty, medical necessity and/or standard of care, supporting efforts to enhance the overall quality and integrity of health care and your profession. Please note, this is not an employed position and our contracted fee is based on credential and specialty type. Duties and Responsibilities - Conduct objective, evidence-based peer reviews of clinical cases. - Make final determinations regarding medical necessity and quality of care. - Ensure decisions are fair, unbiased, and aligned with current standards of practice. - Submit reviews in a timely and professional manner using the IT systems provided. Qualifications - Medical License: Must hold an unrestricted medical license in any U.S. state. - Board Certification: Required (if applicable), through a board recognized by: - The American Board of Medical Specialties (ABMS), - The American Osteopathic Association (AOA), or - Another nationally recognized board granting certification. - Clinical Experience: - Have at least five (5) years full-time equivalent experience providing direct clinical care to patients. - Have experience providing direct clinical care to patients within the past three (3) years. - Knowledgeable of the issue under review, or of the current, evidence-based clinical guidelines and novel treatments for the medical or behavioral health condition, disease, treatment, or procedure under review. - Have the clinical expertise to manage the medical or behavioral health condition or disease under review. - Must be actively engaged in direct or virtual patient care for at least 20 hours per week. Administrative work does not qualify. Technology Requirements - Reliable Wi-Fi access. - Proficiency with Microsoft Word. - Access to a computer compatible with iMPROve Health’s IT systems. Other Requirements - Must complete the electronic credentialing application and receive organizational approval prior to performing a case review. - Must complete a conflict of interest attestation upon credentialing and prior to performing a case review. - Active hospital medical staff privileges may be required, as applicable. - Notify the organization in a timely manner of an adverse change in licensure or certification status, including board certification status. - Cannot have current employment or affiliation with any Veterans Affairs (VA) hospital, health care system, or medical center if applying to perform VA-related peer reviews. Benefits - Make a Difference: Use your clinical knowledge to improve the quality of care patients receive. - Professional Recognition: Join a network of highly respected experts in your specialty. - Competitive Compensation: Receive fair pay for your time and expertise. - Protect Standards of Care: Help uphold the integrity of your profession. - Work Remotely: Review cases from the convenience of your home or office.