Medical Director (Remote)

Availity

13d • 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 13 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 VP of Software Engineering, the Medical Director will lead a team of UM RN Analysts responsible for producing Availity’s Auth AI platform. Specifically, the Medical Director will provide input and oversight of the interpretation of payer medical policy guidelines, the construction of NLP/AI–enabled attestation trees reflective of the medical necessity criteria and clinical validation of the platform. 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 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. Location: Remote, US

Requirements

• MD/DO with at least 8 years of clinical experience.
• At least 5 years of experience in the healthcare revenue cycle roles including Utilization Management, prior authorization, claims appeals/denials, either with an insurer or with a healthcare provider.
• Detail oriented with strong analytic reasoning skills.
• Excellent communication and organizational skills.
• Open-minded, embracing change and the spirit of innovation.
• Ability to use camera for all virtual meetings.

Nice To Haves

• Prior experience working in healthcare information technology.
• Prior experience working with cross-functional teams.
• Deep, working knowledge of the healthcare insurance industry and relevant state and federal regulations.
• Experience working or interacting with payer medical policy teams including experience performing peer-to-peer conversations or 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.
• Strong leadership and delegation skills.
• Still practice medicine, but share a passion for fixing a broken system.

Responsibilities

• Providing oversight and input to the clinical team of UM nurses and prior authorization specialists throughout the product development process from the point of initial review of medical policy through the release of NLP/AI-enabled attestation trees into production.
• 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.
• Ensuring effective flow of all tasks related to the delivery of medical policy creation including tree creation, labeling, and MD validation.
• Providing input to the NLP team to enhance validity and accuracy of the NLP outputs and to identify additional medical terms that should be added to the existing vocabulary of coded concepts.
• Occasionally serve as clinical liaison to the medical policy teams at current customers, including serving as 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 for gym memberships, participation in racing events, weight management programs, etc. (up to $250/year)
• Education reimbursement
• Paid Parental Leave for both moms and dads, both birth parents and adoptive parents.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Number of Employees: 501-1,000 employees