Manager, Clinical Escalations

Cohere Health

. Design and implement a formal escalation framework, including intake processes, triage criteria, severity classifications, tracking mechanisms, and reporting cadences .

Posted 11/10/2026full-timeRemote • United StatesMid-LevelSenior💰 $116,000 - $125,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in managing client and provider escalations within healthcare, ensuring compliance with regulatory requirements and implementing process improvements. Proficient in data analysis and reporting to track escalation metrics and drive systemic solutions.

Highest-signal resume keywords

Utilization Management OperationsHealthcare Regulations KnowledgeProcess Improvement ImplementationClient Communication ExperiencePeople Leadership Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Data AnalysisRoot Cause AnalysisCorrective Action Plan DevelopmentEscalation ManagementDashboard Development

Soft Skills

Problem-SolvingCustomer FocusIndependent FunctioningCross-Functional Collaboration

Tools & Technologies

CRM SoftwareJIRAMonday.comSpreadsheet Functions

Certifications & Qualifications

Active Clinical Licensure

Industry Keywords

HealthcareCMSMedicaidJCAHOEscalation Framework

About the role

Key responsibilities & impact

Design and implement a formal escalation framework, including intake processes, triage criteria, severity classifications, tracking mechanisms, and reporting cadences
Transition the escalation function from the Client Success team into a dedicated program
Serve as the primary point of accountability for incoming client and provider escalations
Categorize, assign, and resolve escalations according to defined workflows
Monitor open escalations and ensure follow-up actions are completed and documented
Hold internal teams accountable for timely closure
Track and enforce regulatory and contractual response-time requirements
Flag risks and implement corrective actions when turnaround times are at risk
Manage sensitive executive-level client or provider escalations
Communicate escalation risks to Cohere leadership
Manage, coach, and support one direct report, the Escalations Analyst
Develop dashboards and reporting on escalation volume, resolution rates, turnaround-time compliance, root causes, and trends
Partner with Client Success, Clinical Operations, Compliance, Product, Clinical Content, and other teams to address systemic issues
Create and maintain SOPs, escalation playbooks, and communication templates

Requirements

What you’ll need

Bachelor's degree in healthcare
Active clinical licensure in state of residence (RN, PT/OT/SLP considered)
3+ years of experience in utilization management operations
Experience in external client, provider, and/or member communications
Knowledge of healthcare regulations and accreditation (CMS, Medicaid, JCAHO)
Proficiency with spreadsheet functions, including data analysis and drawing quantitative conclusions
Experience implementing process improvements
Ability to function independently and navigate ambiguity to build a cross-functional program
Strong problem-solving skills with a customer focus
Passion for improving the U.S. healthcare system and helping ensure every patient receives the best care possible
Familiarity with ticketing or project management software (e.g., CRM, JIRA, Monday.com) is a plus
Demonstrated success implementing new programs is a plus
People leadership experience is a plus
Experience managing escalations in a multi-client or multi-health-plan environment is a plus
Familiarity with root cause analysis (RCA) methodologies and corrective action plan (CAP) development is a plus

Benefits

Comp & perks

Fully remote opportunity with about 10% 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
Bonus included in total benefits package