Medical Director, Clinical Informatics (Remote)

Availity; Northern (KY); Hybrid; USD 180,000 - 320,000; Full time

Benefits offered by this job

Healthcare benefits

401k match

Unlimited PTO

Education reimbursement

Parental leave

Gym reimbursement

Job summary

Availity is seeking a Medical Director, Clinical Informatics to oversee the clinical content that underpins our AI-enabled decision support tools. Remote US-based, with collaboration across Product, Engineering and Clinical teams, you will ensure medical policies and guidelines are accurately reflected in attestation trees.

You will lead clinical validation, develop domain knowledge, and advise on policy interpretation and workflow considerations, helping transform healthcare through data-driven

Qualifications

• MD/DO with at least 8 years of clinical experience.
• 5+ years in healthcare revenue cycle roles including utilization management, prior authorization, and claims appeals/denials.
• Experience working in healthcare information technology and with cross-functional teams.

Responsibilities

• Provide oversight to the extended clinical team during product development from policy review to AI-enabled attestation trees.
• Develop domain knowledge and use tools to map coded medical constructs to attestation trees for automated responses.
• Guide clinical oversight for attestation questions, decision pathways, and clinical workflow alignment.
• Support delivery of clinical decision support tools and validate performance and accuracy.
• Review audits and customer feedback to improve decision trees and vocabulary of coded concepts.
• Contribute thought leadership for innovation initiatives and product enhancements.
• Advise Product, Engineering and customer teams on policy interpretation and clinical workflow considerations.
• Occasionally serve as clinical liaison to medical policy teams at customers.

Skills

Clinical reasoning

Analytical thinking

Cross-functional collaboration

Medical policy interpretation

Education

MD/DO with 8+ years experience

Tools

Domain-specific programming language

Job description

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 12 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 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.
• We allow our associates to reimburse up to $250/year for gym memberships, participation in racing events, weight management programs, etc.
• We offer education reimbursement!
• Availity offers Paid Parental Leave for both moms and dads, both birth parents and adoptive parents.

Disclaimers:

Availity is an equal opportunity employer and makes decisions in employment matters without regard to race, religious creed, color, age, sex, sexual orientation, gender identity, gender expression, genetic information, national origin, religion, marital status, medical condition, disability, military service, pregnancy, childbirth and related medical conditions, or any other classification protected by federal, state, and local laws and ordinances. Availity is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. NOTICE: Federal law requires all employers to verify the identity and employment eligibility of all persons hired to work in the United States. When required by state law or federal regulation, Availity uses I-9, Employment Eligibility Verification in conjunction with E-Verify to determine employment eligibility. Learn more about E-Verify at http://www.dhs.gov/e-verify. Click the links below to view Federal Employment Notices. Family & Medical Leave Act Equal Employment Law Poster Pay Transparency Employee Polygraph Protection Act IER Right to Work Poster Important Notice about Employee Rights to Organize and Bargain Collectively with Their Employers We love what we do. More importantly, we love where we do it. If you enjoy talented, positive people who are dedicated to working together to create awesome products and solutions, then Availity is the place for you. The work is challenging but the rewards run deep, as do the opportunities for growth. Come make your mark in a place where you will love what you do.