Medical Director, Clinical Informatics (Remote)

Availity

2d•Remote

About The Position

Availity delivers revenue cycle and related business solutions for health care professionals who want to build healthy, thriving organizations. Availity has the powerful tools, actionable insights and expansive network reach that medical businesses need to get an edge in an industry constantly redefined by change. At Availity, we're not just another Healthcare Technology company; we're pioneers reshaping the future of healthcare! With our headquarters in vibrant Jacksonville, FL, and an exciting office in Bangalore, India, along with an exceptional remote workforce across the United States, we're a global team united by a powerful mission. We're on a mission to bring the focus back to what truly matters – patient care. As the leading healthcare engagement platform, we're the heartbeat of an industry that impacts millions. With over 2 million providers connected to health plans, and processing over 12 billion transactions annually, our influence is continually expanding. Join our energetic, dynamic, and forward-thinking team where your ideas are celebrated, innovation is encouraged, and every contribution counts. We're transforming the healthcare landscape, solving communication challenges, and creating connections that empower the nation's premier healthcare ecosystem. Reporting to the Chief Medical Officer, 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) the construction and maintenance of AI–enabled attestation trees reflecting applicable clinical content, and clinical validation of the platform overall. The Medical Director will also be responsible for supporting development of additional use cases, supporting customer interactions and engaging 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, and prior authorization adjudication practices. This person will work in a team environment and will be expected to perform complex tasks while collaborating with colleagues with clinical and engineering/programming backgrounds. The successful candidate will display experience in learning, using and optimizing use of a variety of technology and tooling in supporting day-to-day tasks. The candidate will also be detail oriented with strong analytic reasoning skills, demonstrate excellent communication and organizational skills while remaining open-minded, embracing change and the spirit of innovation. Sponsorship, in any form, is not available for this position.

Requirements

MD/DO with at least 8 years of clinical experience.
5 plus years of experience in the healthcare revenue cycle roles including utilization management, prior authorization, and claims appeals/denials, within a payer, provider or healthcare technology environment.
Prior experience working in healthcare information technology and with cross-functional teams.
In-depth knowledge of utilization management principles, the purpose and function of medical necessity guidelines, and prior authorization adjudication practices.
Experience in learning, using and optimizing use of a variety of technology and tooling in supporting day-to-day tasks.
Detail oriented with strong analytic reasoning skills.
Excellent communication and organizational skills.
Open-minded, embracing change and the spirit of innovation.
Ability to use your camera for all virtual meetings.

Nice To Haves

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 team members with diverse skillsets to create solutions.
Self-motivated and a quick learner with an ability to multi-task.
Passionate about fixing a broken system.

Responsibilities

Providing oversight and input to the extended clinical team throughout the product development process from the point of initial review of medical policy through the release of AI-enabled attestation trees into production. This entails developing a working knowledge of a domain-specific programming language and use of development tools to assign coded medical constructs to attestation trees to facilitate automation of their responses.
Guiding clinical oversight for teams responsible for building and maintaining clinical content attestation questions, decision pathways, and recommendation logic that accurately reflect medical policy or other clinical guidelines requirements.
Timely support of all assigned tasks related to the delivery of clinical decision support tools, including decision tree creation, clinical concept labeling, and clinical performance validation.
Reviewing audit findings, customer feedback, and implementation observations to identify opportunities for decision tree improvement and providing input to enhance validity and accuracy of the AI outputs, including identification of additional medical terms that should be added to the existing vocabulary of coded concepts.
Contributing thought leadership, clinical design, and operational support for innovation initiatives (e.g., alpha/beta customer support) and other product enhancement efforts and feature development.
Advising on clinical guidance and support to Product, Engineering and customer-facing teams (e.g., implementation, sales and account teams) regarding decision tree behavior, policy/guidelines interpretation, and clinical workflow considerations.
Occasionally serving as clinical liaison to the medical policy and utilization management teams at current customers, including serving as a non-voting member of their medical policy committees.

Benefits

Competitive salary
Bonus structure
Generous HSA company contribution
Healthcare
Vision
Dental benefits
401k match program
Unlimited PTO for salaried associates
9 paid holidays
Reimbursement up to $250/year for gym memberships, participation in racing events, weight management programs, etc.
Education reimbursement
Paid Parental Leave for both moms and dads, both birth parents and adoptive parents.