[Hiring] Medical Director, Clinical Informatics @Availity

Role Description

The Medical Director, Clinical Informatics will be responsible for supporting delivery of content that forms the clinical knowledge base of Availity’s clinical decision support tools. Specifically, the Medical Director will:

• Provide input and oversight for the interpretation of external clinical content (e.g., medical policies, clinical guidelines, and reimbursement policies).
• Construct and maintain AI-enabled attestation trees reflecting applicable clinical content.
• Ensure clinical validation of the platform overall.
• Support development of additional use cases.
• Engage in cross-functional collaboration with Product, Engineering, and Clinical Informatics peers.

The role requires an in-depth knowledge of:

• Utilization management principles.
• The purpose and function of medical necessity guidelines.
• Prior authorization adjudication practices.

The successful candidate will:

• Display experience in learning, using, and optimizing a variety of technology and tooling.
• Be detail-oriented with strong analytic reasoning skills.
• Demonstrate excellent communication and organizational skills.
• Remain open-minded, embracing change and the spirit of innovation.

Qualifications

• MD/DO with at least 8 years of clinical experience.
• 5 plus years of experience in healthcare revenue cycle roles including utilization management, prior authorization, and claims appeals/denials.
• Prior experience working in healthcare information technology and with cross-functional teams.

Requirements

• Deep working knowledge of the healthcare insurance industry and relevant state and federal regulations.
• Experience working or interacting with payer medical policy teams including serving on medical policy committees.
• Exceptional critical thinking and reasoning skills.
• Ability to synthesize complex, abstract problems and collaborate effectively with diverse team members.
• Self-motivated and a quick learner with the ability to multi-task.
• Passionate about fixing a broken system.

Benefits

• Competitive salary and bonus structure.
• Generous HSA company contribution.
• Healthcare, vision, dental benefits.
• 401k match program available from day one.
• Unlimited PTO for salaried associates + 9 paid holidays.
• Hourly associates start at 19 days of PTO with the same holiday benefits.
• Reimbursement up to $250/year for wellness activities.
• Education reimbursement available.
• Paid Parental Leave for both birth and adoptive parents.
• Opportunities to engage in community service through partnerships with various organizations.