AI-Driven Nurse Analyst - Clinical Informatics

Availity; Northern (KY); Hybrid; USD 110,000 - 140,000; Full time

Benefits offered by this job

Great Place to Work

Education reimbursement

Paid Parental Leave

401k match

Unlimited PTO

Job summary

Availity is seeking a UM Nurse Analyst (Clinical Informaticist) to translate payer medical policies into structured decision pathways for AI-enabled workflows. You will validate clinical alignment, support implementation, and collaborate across Product, Engineering, and clinical informatics teams to ensure decisions reflect medical necessity criteria.

The role emphasizes attention to detail, strong analytic reasoning, and the ability to adapt in a fast-changing environment.

Qualifications

• Bachelor’s degree in nursing.
• 3+ years in Utilization Management or equivalent clinical experience with prior authorization knowledge.
• Strong understanding of medical necessity criteria and payer policy structure.
• Ability to communicate clinical rationale clearly to technical, operational, and customer-facing stakeholders.

Responsibilities

• Review payer Medical Policy Guidelines to identify medical necessity criteria.
• Build and maintain attestation questions, decision pathways, and recommendation logic.
• Provide clinical guidance to Product Operations, Engineering and customer-facing teams.
• Review policy updates and support release readiness efforts.

Skills

Utilization Management

Medical policy interpretation

Prior authorization workflows

CPT/HCPCS/ICD-10 familiarity

Education

Bachelor’s degree in nursing

Job description

Availity is seeking a UM Nurse Analyst (Clinical Informaticist) to translate payer medical policies into structured decision pathways for AI-enabled workflows. You will validate clinical alignment, support implementation, and collaborate across Product, Engineering, and clinical informatics teams to ensure decisions reflect medical necessity criteria.

The role emphasizes attention to detail, strong analytic reasoning, and the ability to adapt in a fast-changing environment.