Clinical Functional Consultant - Registered Nurse (RN) - Payer

Infinite Computer Solutions; United States; On-site; USD 110,000 - 160,000; Full time

Job summary

Infinite Computer Solutions seeks a Senior Clinical Functional Consultant to bring clinical expertise into designing and implementing healthcare workflows within TruCare Next Gen and Symphony. You will work with nurses, medical directors, utilization-management leaders and stakeholders to translate workflows into product requirements and system behavior.

The ideal candidate blends clinical credibility with workflow, requirements and technology orientation, and will translate clinical processes

Qualifications

• RN preferred; other clinical degrees considered based on experience.
• 5+ years in payer clinical operations or healthcare technology implementation.
• Strong understanding of clinical workflow and payer processes.
• Experience translating clinical processes into technology requirements.
• Familiarity with AI-enabled decision support and human-in-the-loop workflows.

Responsibilities

• Lead workflow and requirements sessions with client clinical and operational stakeholders.
• Understand and document utilization management, prior authorization, care management workflows.
• Model clinical roles, decision points, business rules and human-review requirements.
• Translate workflows into functional requirements, product configurations and user stories.
• Map requirements to TruCare Next Gen and Symphony capabilities and identify gaps.
• Partner with product teams on medical-policy application and clinical decision-support.
• Define where automation and AI can support workflows and where human review is needed.
• Design clinician acceptance, override and escalation patterns for AI-enabled workflows.
• Identify workflow variations across markets, products, or regulations.
• Validate configured workflows with client clinical stakeholders.
• Support clinical UAT, scenario development, and go-live readiness.
• Collaborate with product managers, solution architects, engineering and implementation teams.
• Ensure workflows remain understandable and practical for end users.

Skills

Clinical workflow

Requirements development

Workflow modeling

Client communication

Facilitation

Healthcare IT

AI-enabled workflows

User stories

Product collaboration

Education

RN strongly preferred

MD/DO considered

Clinical degree

Job description

Senior Clinical Functional Consultant – Healthcare Workflow & Product to bring clinical expertise into the design and implementation of healthcare workflows within TruCare Next Gen and Symphony.

The individual will work directly with client nurses, medical directors, utilization-management leaders and operational stakeholders to understand clinical workflows and translate them into product requirements, configurations, decision points and system behavior.

The ideal candidate combines clinical credibility with strong workflow, requirements and technology orientation. This person should be equally comfortable discussing how a nurse performs a clinical review and working with product and engineering teams to determine how that workflow should be represented within the platform.

Key Responsibilities

• Lead detailed workflow and requirements sessions with client clinical and operational stakeholders.
• Understand and document utilization management, prior authorization, care management and related clinical workflows.
• Model clinical roles, decision points, business rules, exceptions, escalations and human-review requirements.
• Translate clinical workflows into functional requirements, product configurations, business rules, user stories and acceptance criteria.
• Map requirements to existing TruCare Next Gen and Symphony capabilities and identify configuration, integration or product gaps.
• Partner with product teams on medical-policy application, clinical decision-support and related workflow capabilities.
• Help define where automation and AI can appropriately support clinical workflows and where human review or intervention is required.
• Help design appropriate clinician acceptance, override and escalation patterns for AI-enabled workflows.
• Identify workflow variations associated with different markets, products, lines of business or regulatory requirements.
• Validate configured workflows with client clinical stakeholders.
• Support clinical UAT, scenario development, implementation readiness and go-live.
• Work closely with product managers, Functional Consultants, Solution Architects, engineering and implementation teams.
• Ensure clinical workflows remain understandable, traceable and practical for end users.

Qualifications

• RN strongly preferred; MD/DO or other relevant clinical degree considered depending on experience.
• 5+ years of experience in payer clinical operations, utilization management, prior authorization, care management and/or healthcare technology implementation.
• Strong understanding of clinical workflow and payer medical-management processes.
• Experience translating clinical processes into technology requirements, configurations or workflows.
• Experience working with healthcare software products strongly preferred.
• Familiarity with clinical guidelines, medical policies and clinical decision-support processes desirable.
• Comfortable working with AI-enabled decision support and human-in-the-loop workflows.
• Strong analytical, requirements-development and workflow-modeling skills.
• Excellent client-facing communication and facilitation skills.