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Active15h ago

Sr. Director, Cinical Operations

Cohere Health·📍 Hyderabad, Telangana, India

Employment

Full-Time

Work mode

On-site

Experience

DIRECTOR

Salary

Not disclosed

Salary not disclosed

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Role overview

Job description

Opportunity Overview: The Sr. Director, GIC India Clinical Operations is a foundational leadership role responsible for establishing, scaling, and managing the clinical RN review function within Cohere Health's Global Innovation Center (GIC) in Hyderabad, India. This leader will build a high-performing team of US NCLEX-certified Registered Nurses (NCLEX-RNs) who perform prospective, concurrent, and retrospective clinical reviews for prior authorization cases on behalf of Cohere Health's US payer clients. The Sr. Director will be accountable for the end-to-end clinical operations delivery from the India GIC, ensuring that RN reviewers assess medical records and clinical documentation for appropriateness and medical necessity in strict alignment with clinical guidelines (including MCG Care Guidelines), Cohere Health internal criteria, National and Local Coverage Determinations (NCD/LCD), a

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What they are looking for

Skills & requirements

Qualification

Education Bachelor's degree in Nursing (BSN) — Required Active, US Registered Nurse license (NCLEX-RN) — Required Clinical & Professional Experience Minimum 12–15 years of progressive experience in clinical operations, utilization management, and/or healthcare operations, with at least 5 years in a senior leadership role Knowledge and experience in utilization review / utilization management, including prospective (prior authorization), concurrent, and retrospective review Proven experience setting up and managing clinical operations in a GCC/GIC/BPO/offshore environment, preferably serving US healthcare payer clients Demonstrated expertise in US healthcare delivery systems, payer operations, and the prior authorization lifecycle across Commercial, Medicare, and Medicaid lines of business Hands-on experience with clinical criteria sets including MCG Care Guidelines, InterQual, and/or equivalent evidence-based criteria Experience managing NCLEX-certified RN teams in India or other offshore locations Knowledge of clinical algorithms, care pathways, and utilization management across the care continuum (acute care, post-acute care, ambulatory, outpatient) Experience with CMS regulatory

Department · Nurse Operations

Hiring company

Cohere Health

Technology

AI-powered prior authorization and payment integrity solutions that streamline utilization management, reduce costs, and improve care access for health plans.

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