[Hiring] Vice President, Clinical Operations @Availity

Role Description

This is a rare chance to build something meaningful at the intersection of healthcare, AI, and operations. As the Vice President, Clinical Operations, Auth AI, you will lead the strategy and execution behind AuthAI’s clinical delivery model, helping scale an innovative solution that is transforming utilization management. If you thrive in high-impact roles, love building from the ground up, and want to shape the future of AI-enabled healthcare, this is the opportunity to do it.

Location: Remote, US

Why you want to work on this team:

• Passionate about building and leading a high-impact clinical operations function at the intersection of healthcare, AI, and innovation.
• Enjoy shaping strategy across the business by partnering with product, data, sales, and client teams on a fast-growing solution.
• Opportunity to make meaningful impact by improving utilization management workflows and helping healthcare organizations deliver better patient outcomes.

Qualifications

• Undergraduate degree in nursing, healthcare administration, business, or other relevant field.
• 3–4+ years of progressive leadership experience in a healthcare setting to include change management.
• Prior relevant experience in healthcare or utilization management strongly preferred, including experience in leading operations teams.
• Payer experience and understanding of health plan operations.
• Experience in leading teams through change and periods of rapid growth.
• Advanced proficiency in Microsoft Office suite.
• Solid understanding of regulatory and compliance implications within UM workflows, including implications for application of AI.
• Knowledge of industry standards around interoperability, including knowledge of UM platforms, EMR integrations, and clinical data exchange standards.
• Excellent problem-solving, critical thinking, and attention to detail.
• Strong written and verbal communication skills, including ability to present to executives.

Requirements

• Deep payer-side utilization management expertise with the ability to translate clinical complexity into scalable operational models.
• Proven success building and leading teams through growth, change, and cross-functional execution.
• Strong fluency in AI-enabled clinical workflows with the credibility to influence both executive stakeholders and technical partners.

What you will be doing:

• Owning clinical delivery timelines and planning, coordinated with the overall delivery lead.
• Overseeing pre-sales scoping, timelines, and clinical resource planning to ensure scalable, efficient, and compliant delivery commitments.
• Ensuring clinical scope contract sign-off is governed and consistently executed.
• Creating strong clinical oversight models, including build of clinical tooling to support efficiency and standardization.
• Leading policy mapping and ensuring operational readiness for clinical content execution.
• Owning DAG creation, ongoing policy updates, and DAG maintenance with disciplined change control.
• Providing DAG oversight and accountability for quality, consistency, and operational sustainability.
• Establishing and running SLA auditing, including review of findings and action plans, including close collaboration with clinical account managers.
• Leading clinical audits, including bug creation and clinical performance remediation pathways.
• Reviewing product performance and client reporting outcomes and supporting coordinated improvement efforts across teams (engineering, data science, and product).
• Owning clinical release updates and serving as Clinical Release POC for coordinated readiness and communication.
• Driving operational rigor across clinical QA and delivery processes to reduce defects and improve consistency.
• Providing sales support, including demo use case consistency and deep UM workflow expertise.
• Delivering client education on AI, product process, reporting, and serving as clinical SME support for AEs/CSMs.
• Managing and resolving client escalations for clinical issues, ensuring timely triage and resolution.
• Leading AuthAI CR triage and managing AuthAI client escalations, ensuring consistent workflows and rapid issue resolution.
• Partnering in a product dyad to drive clinical program design and requirements build that aligns clinical needs with product execution.
• Supporting development and delivery of client-specific roadmaps from a clinical feasibility and outcomes standpoint.
• Serving as SME and leader for regulatory and accreditation needs.
• Establishing and leading AI and clinical governance models, including extension/connection to UM specific CAB where applicable.
• Providing thought leadership, clinical design and operational support for innovation initiatives (e.g., alpha/beta customer support).
• Overseeing NLP and labeling processes to ensure clinical integrity and operational scalability.
• Acting as clinical partner to Data & Analytics to improve reporting, insights, and clinical performance management.
• Serving as SME for TCoC & VBC (Total Cost of Care and Value-Based Care).
• Acting as clinical SME to establish Availity’s position as a trusted industry advisor in the UM space.

Benefits

• Competitive salary and bonus structure.
• Generous HSA company contribution, healthcare, vision, dental benefits, and a 401k match program available from day one.
• Unlimited PTO for salaried associates + 9 paid holidays; hourly associates start at 19 days of PTO.
• Reimbursement up to $250/year for gym memberships, racing events, weight management programs, etc.
• Education reimbursement for furthering your education.
• Paid Parental Leave for both birth and adoptive parents.
• Opportunities to engage with community organizations through volunteer efforts.