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.

Location: Remote, US

Why you want to work on this team:

• Work on a team that is shaping Availity’s AI-powered clinical capabilities during a period of growth and transformation.
• Join a highly collaborative team that sits at the intersection of healthcare, clinical operations, and AI, helping shape solutions that can impact millions of healthcare transactions across the industry.

To be qualified for this position you have:

• 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.

You will set yourself apart with:

• 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.

What you will be doing:

• 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. 

Availity culture and benefits:

• Availity is a certified “Great Place to Work”! Culture is important to us and there are many ways for you to make your mark here!
• We have several Culture teams, a Young Professionals Group, and various ways to engage with fellow Availity associates – if you’re near Jacksonville, we have lots of pop up lunches where lunch is provided for everyone when we can see meetings are taking place and we’ve got teams in the office. 
• Availity is a culture of continuous learning. We have many resources and experts in our tech stack and in our industry that can help get you there too!
• Don’t feel like wearing business attire? Cool, you can wear jeans – we are a casual place.
• We offer a competitive salary, bonus structure, generous HSA company contribution, healthcare, vision, dental benefits and a 401k match program that you can take advantage of on day one! 
• We offer unlimited PTO for salaried associates + 9 paid holidays. Hourly associates start at 19 days of PTO and go up from there with all the same holiday benefits. 
• Interested in wellness? We allow our associates to reimburse up to $250/year for gym memberships, participation in racing events, weight management programs, etc.
• Interested in furthering your education? We offer education reimbursement!
• Availity offers Paid Parental Leave for both moms and dads, both birth parents and adoptive parents. 
• Want to work for an organization that gives back to the community? You’re at the right place! Availity partners with various organizations, both locally and nationally, to raise awareness, funds and morale as our staff members volunteer their time and funds to engage the organizations campaign.

Next steps:

After you apply, you will receive text/email messages thanking you for applying and then you will continue to receive more text/email messages alerting you as to where you are in the recruitment process. 

Interview process: 

• Recruiter Video Pre-Screen
• Video Interview with Clinical Panel
• Video Interview with Technology Panel
• Video Interview with Product Panel
• Video Interview with Chief Medical Officer

Video Camera Usage:

Availity fosters a collaborative and open culture where communication and engagement are central to our success.  As a remote first company, we are also camera-first and provide all associates with camera/video capability to simulate the office environment. If you are not able to use your camera for all virtual meetings, you should not apply for this role.

Having cameras on helps create a more connected, interactive, and productive environment, allowing teams to communicate more effectively and build stronger working relationships.  The usage of cameras also enhances security and protects sensitive company information. Video participation is required to ensure that only authorized personnel are present in meetings and to prevent unauthorized access, data breaches, preventing social engineering, or the sharing of confidential information with non-participants.