Medical Director, Clinical Informatics

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

📋 Description

• Directly report to the Chief Medical Officer.

• Assist in delivering content that constitutes Availity’s clinical knowledge base for clinical decision support tools.

• Analyze external clinical content, which includes medical policies, clinical guidelines, and reimbursement policies.

• Supervise the development and upkeep of AI-enabled attestation trees.

• Validate the clinical aspects of the platform.

• Aid in creating additional use cases and facilitating customer interactions.

• Collaborate across various functions, including Product, Engineering, and Clinical Informatics teams.

• Provide guidance and oversight throughout the product development process, from the initial medical policy review to the production release of AI-enabled attestation trees.

• Assign coded medical constructs to attestation trees using a domain-specific programming language and relevant development tools.

• Direct clinical oversight for teams responsible for building and maintaining clinical content attestation questions, decision pathways, and recommendation logic.

• Complete tasks related to the delivery of clinical decision support tools, such as decision tree creation, clinical concept labeling, and clinical performance validation.

• Review audit results, customer feedback, and implementation observations to pinpoint enhancements for decision trees.

• Improve the validity and accuracy of AI outputs and identify additional medical terms for the coded concept vocabulary.

• Provide thought leadership, clinical design, and operational support for innovation initiatives, including alpha/beta customer support.

• Assist in product enhancements and feature development.

• Counsel Product, Engineering, implementation, sales, and account teams regarding decision tree behavior, policy/guideline interpretation, and clinical workflow considerations.

• Occasionally act as a clinical liaison to customer medical policy and utilization management teams.

• Occasionally participate as a non-voting member of customer medical policy committees.

⛳️ Requirements

• MD/DO degree.

• Minimum of 8 years of clinical experience.

• Over 5 years of experience in healthcare revenue cycle roles, including utilization management, prior authorization, and claims appeals/denials, within a payer, provider, or healthcare technology setting.

• Previous experience in healthcare information technology.

• Experience working with cross-functional teams.

• Comprehensive understanding of utilization management principles.

• Familiarity with the purpose and function of medical necessity guidelines.

• Knowledge of prior authorization adjudication practices.

• Extensive working knowledge of the healthcare insurance industry and pertinent state and federal regulations.

• Experience working or interacting with payer medical policy teams, including participation in medical policy committees.

• Proficient in learning, utilizing, and optimizing various technologies and tools.

• Ability to acquire a working knowledge of a domain-specific programming language and utilize development tools.

• Outstanding critical thinking and reasoning abilities.

• Strong analytical reasoning skills.

• Excellent communication and organizational capabilities.

• Ability to synthesize complex, abstract problems and collaborate effectively with team members possessing diverse skill sets.

• Self-motivated, quick learner, and capable of multitasking.

• Must be able to use a camera for all virtual meetings.

• Must pass a drug test prior to commencing employment.

• Must meet U.S. employment eligibility verification requirements.

• Sponsorship is not available.

🏝️ Benefits

• Competitive salary.

• Bonus structure.

• Generous HSA company contribution.

• Comprehensive healthcare benefits.

• Vision benefits.

• Dental benefits.

• 401k matching program available from day one.

• Unlimited PTO for salaried associates.

• 9 paid holidays.

• Wellness reimbursement of up to $250/year for gym memberships, racing events, weight management programs, and more.

• Education reimbursement.

• Paid Parental Leave for birth and adoptive parents.

• Culture teams and Young Professionals Group.

• Pop-up lunches in Jacksonville when teams are in the office.

• Continuous learning resources and expert access.

• Casual dress code, including jeans.

• Remote-first work environment.

• Camera/video capability provided for associates.

• Opportunities for community volunteering and charitable engagement.