Employer description & source details
Lead the end-to-end setup and operationalization of the clinical RN review function at the Hyderabad GIC, including infrastructure, workflows, staffing models, and technology enablement via Cohere Unify™ Design and implement a scalable operating model for clinical prior authorization reviews across multiple delegated specialties (e.g., musculoskeletal, cardiology, radiology, diagnostic imaging) served by Cohere Health's payer clients Develop and maintain Standard Operating Procedures (SOPs), work instructions, clinical review protocols, and decision-support frameworks aligned with US clinical standards Establish a shift operations model to ensure overlap with US business hours based on client requirements for real-time case collaboration with US clinical leads and Medical Directors Partner with US Clinical Operations leadership to define scope boundaries — ensuring the India team handles clinical documentation review, medical necessity assessment support, and case preparation, while US-based clinical leads retain final determination authority for regulated states Talent Acquisition, Development & Management Recruit, hire, and onboard a team of US NCLEX-certified RNs in India with strong clinical backgrounds, utilization management experience, and familiarity with US healthcare delivery systems Build and sustain a robust talent pipeline for NCLEX-RN professionals in the Hyderabad market, partnering with HR and external agencies as needed Implement and oversee a comprehensive 6-week blended training program for newly hired RNs: Weeks 1–2: US healthcare system foundations (payer landscape, regulatory environment, medical terminology, clinical documentation standards) Weeks 3–4: Cohere Unify™ platform training, UM workflow training, MCG, CMS Care Guidelines, and Cohere Heal
Extracted skills: security, operations