VP, Clinical Integrity

Accuity

23h•Remote

About The Position

The Vice President, Clinical Integrity is a senior physician executive responsible for establishing and advancing Accuity’s clinical integrity strategy, governance framework, and clinical risk and compliance standards. Reporting to the Chief Medical Officer/Chief Medical Information Officer, this role provides enterprise leadership for the clinical accuracy, defensibility, consistency, and responsible use of Clinical Intelligence capabilities. The role also leads the Clinical Integrity escalation and disagreement function and provides consultative physician support to related cross-functional workflows. The VP, Clinical Integrity sets standards, decision frameworks, and oversight practices that support clinically accurate and compliant outcomes across technology-enabled workflows, ensuring best practices and efficiency gains are realized. Key performance expectations include leading cross-functional efforts to reduce avoidable or recurrent internal and client disagreements by 50%, measured by both case count and dollar impact against agreed baselines; achieve 95% or higher compliance on applicable third-party and client audits; achieve 80% or higher actualization of high-value, compliant changes; and develop and implement best practices for contingency-fee clients that support the actualization of compliant changes. These goals must be pursued without compromising clinical accuracy, coding compliance, or appropriate escalation. Baselines, timeframes, attribution, and measurement methodologies will be established with executive leadership and the relevant functional owners. This leader partners with Clinical Operations, Product, Analytics, Compliance, and client-facing teams to ensure clinical requirements are translated into scalable solutions, risks are appropriately managed, and performance remains aligned with clinical, regulatory, operational, and business expectations.

Requirements

Doctor of Medicine or Doctor of Osteopathic Medicine degree required.
Current board certification in a recognized medical specialty required.
Active, unrestricted medical license required.
12+ years of progressive experience in physician leadership, clinical operations, clinical informatics, healthcare technology, or a related healthcare environment.
Experience with clinical documentation integrity, coding, revenue cycle, or health-system workflows required.
Executive-level experience leading multidisciplinary teams and complex, cross-functional clinical programs.
Demonstrated success establishing clinical governance, quality, risk, or compliance frameworks.
Experience translating clinical requirements into scalable operational, product, or technology standards.
Employees must be able to communicate via phone, email, etc. and sit for extended periods of time, with or without reasonable accommodations.

Nice To Haves

Formal training or certification in clinical informatics, healthcare quality, compliance, patient safety, or a related discipline preferred.
Experience with AI-enabled healthcare solutions, data-driven clinical tools, or clinical decision support preferred.

Responsibilities

Establish and maintain enterprise standards for clinical accuracy, integrity, defensibility, and evidence-based decision-making.
Develop governance frameworks that define clinical review, validation, approval, escalation, and accountability requirements.
Set standards for the appropriate interpretation and use of clinical documentation, including the management of ambiguity, attribution, timing, and uncertainty.
Ensure Clinical Intelligence capabilities and outputs remain aligned with accepted clinical practices, organizational policies, and client expectations.
Chair or lead governance forums that evaluate clinical priorities, risks, exceptions, and material decisions.
Maintain clear documentation of governance decisions, standards, and approval authorities.
Lead the Clinical Integrity escalation and disagreement team and establish consistent expectations for intake, triage, review, documentation, turnaround time, decision-making, and reporting.
Support the remediation and rebuttal process for escalated clinical or coding disagreements between physician reviewers and Documentation Integrity Specialists (DIS), including cases elevated through their respective management teams.
Provide consultative physician support in resolving disagreements between tower CDI staff and physician reviewers, including development or review of clinically and coding-defensible rebuttals; tower and operational leaders retain ownership of day-to-day workflow and implementation.
Provide clinical subject-matter expertise and case-preparation support to the Denials and Appeals team for selected payer peer-to-peer reviews and Administrative Law Judge (ALJ) proceedings; the Denials and Appeals team retains program and workflow ownership.
Partner with the clinical content librarian, Knowledge Management, CDI, Coding, and other subject-matter experts to support and help coordinate formal review and updating of clinical criteria at least every six months, and sooner when changes in evidence, regulation, policy, or client requirements warrant.
Exercise delegated authority for routine escalations within approved standards and elevate unresolved, precedent-setting, high-risk, or clinically material matters to the CMO/CMIO, who retains final clinical decision authority.
Analyze disagreement, rebuttal, and escalation themes and communicate actionable feedback to clinical, coding, CDI, education, quality, product, and operational leaders.
Provide executive oversight of clinical risks associated with Clinical Intelligence programs, workflows, and technology-enabled solutions.
Establish risk-assessment and control practices designed to identify, evaluate, mitigate, and monitor clinically meaningful issues.
Partner with Compliance, Legal, Quality, and operational leaders to ensure clinical practices support applicable requirements and organizational standards.
Define escalation and response expectations for incidents that may affect clinical accuracy, defensibility, quality, or client outcomes.
Oversee clinical input into root-cause analysis, corrective action planning, and preventive control development.
Advise executive leadership on significant clinical risks, emerging trends, and recommended actions.
Develop and execute the Clinical Integrity strategy in alignment with Accuity’s broader Clinical Intelligence, clinical, product, operational, and business priorities.
Translate enterprise objectives into clear clinical priorities, governance expectations, and measurable outcomes.
Provide executive guidance on investments, sequencing, tradeoffs, and organizational capabilities needed to support sustainable growth.
Monitor changes in healthcare, clinical documentation, technology, and industry practices that may affect Accuity’s clinical strategy or risk profile.
Establish operating rhythms and executive reporting that provide visibility into performance, risks, decisions, and progress.
Serve as a senior clinical advisor to the CMO/CMIO and executive leadership team.
Partner with Product, Engineering, Analytics, and Data Science leaders to embed clinical requirements and safeguards into technology-enabled solutions.
Ensure clinical requirements are clearly defined, appropriately validated, and incorporated into development and implementation practices.
Establish clinical readiness and approval expectations for new capabilities, material changes, and production releases.
Provide clinical oversight for AI-enabled and data-driven capabilities, including expectations for responsible use, monitoring, and ongoing evaluation.
Guide the development of performance measures that assess clinical accuracy, consistency, reliability, and operational impact.
Ensure material clinical risks and limitations are understood, documented, and addressed before deployment or expansion.
Build strong partnerships across Clinical Operations, Product, Technology, Analytics, Compliance, Quality, and client-facing functions.
Align clinical standards with operational workflows, implementation needs, and client commitments.
Provide executive clinical guidance for complex client issues, escalations, and strategic discussions.
Communicate clinical standards, risks, decisions, and recommendations clearly to technical, operational, executive, and client audiences.
Support clinically grounded narratives and materials that strengthen confidence in Accuity’s services and solutions.
Promote shared accountability for clinical integrity across functions.
Lead and develop the Clinical Integrity escalation and disagreement function, including physician, clinical, coding, and operational professionals, as applicable.
Establish clear team structure, decision rights, performance expectations, and accountability.
Recruit, coach, and retain leaders and subject-matter experts capable of supporting current and future business needs.
Build team capability in clinical judgment, governance, risk management, quality oversight, and cross-functional execution.
Ensure effective delegation, succession planning, workload management, and coverage across programs and clinical domains.
Foster a culture of transparency, disciplined decision-making, continuous improvement, and accountability within a fully remote environment.
Establish measures and reporting that evaluate clinical quality, risk, governance effectiveness, and program performance.
Review trends, incidents, audit results, and other performance indicators to identify opportunities for improvement.
Ensure clinical standards and controls remain scalable as programs, clients, and technology capabilities evolve.
Sponsor improvement initiatives that strengthen clinical accuracy, consistency, efficiency, and adoption.
Maintain disciplined documentation and follow-through for significant decisions, risks, and actions.
Perform other job-related duties as assigned.