Clinical AI Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Conduct audits on a substantial number of prior authorizations and AI-generated clinical outputs to ensure accuracy, completeness, and adherence to medical records and relevant payer criteria.

• Utilize evidence-based clinical reasoning to address complex or ambiguous cases.

• Differentiate between clinically significant errors and minor issues.

• Contribute to the development of a scalable system for clinical expertise.

• Recognize recurring error trends, gaps in clinical guidance, and unique cases.

• Analyze root causes and suggest enhancements to review standards and workflows.

• Employ AI tools in clinical review and auditing processes.

• Critically assess AI outputs and explore methods to boost throughput while upholding clinical quality.

• Take ownership of the quality and timeliness of work, fulfilling review expectations, and ensuring issues are resolved.

⛳️ Requirements

• A Doctor of Pharmacy (PharmD) degree is required.

• 2 to 10 years of professional experience, including direct managed care involvement in prior authorization, utilization management, appeals, or clinical quality within a health plan, pharmacy benefit manager (PBM), or a comparable organization.

• Exceptional clinical reasoning skills, including the ability to synthesize medical records, medication histories, payer criteria, and clinical evidence.

• Capability to navigate ambiguity and articulate a defensible conclusion clearly.

• Strong systems thinking skills, with a talent for identifying recurring patterns, root causes, and opportunities for workflow enhancement.

• Accurate written communication and meticulous attention to detail.

• Competence in providing structured feedback that clearly outlines issues, their clinical significance, and necessary corrections.

• Ability to work autonomously, effectively prioritize tasks, and consistently deliver precise work in high volumes.

• Enthusiasm for integrating AI into clinical practices.

• A mindset of intellectual curiosity, a willingness to experiment, and the judgment to challenge AI outputs and modify conclusions when necessary.

🏝️ Benefits

• Comprehensive health insurance coverage.

• Opportunities for continuous professional development and training.

• Flexible work arrangements and a supportive work environment.