Nurse Informaticist for AI-Powered Prior Authorization

AVAILITY; United States; On-site; USD 90,000 - 150,000; Full time

Benefits offered by this job

Unlimited PTO

9 holidays

401k match

Education reimbursement

Parental leave

Healthcare benefits

Job summary

Availity delivers revenue cycle and related business solutions for health care professionals who want to build healthy, thriving organizations. Availity has headquarters in Jacksonville, FL, an office in Bangalore, India, and a nationwide remote workforce across the United States.

The UM Nurse Analyst (Clinical Informaticist) will translate payer medical policies into AI-enabled decision trees, validate clinical alignment, and support automated prior authorization workflows.

Qualifications

• Bachelor's degree in nursing and 3+ years in Utilization Management.
• Strong knowledge of medical necessity criteria and prior authorization.
• Experience interpreting CPT/HCPCS/ICD-10 and payer policies.

Responsibilities

• Review payer Medical Policy Guidelines to identify medical necessity criteria.
• Build and maintain decision pathways and logic reflecting policy requirements and clinical intent.
• Provide clinical guidance to Product Operations, Engineering and customer-facing teams on decision tree behavior and clinical workflow considerations.
• Review and incorporate payer medical policy updates into existing decision trees.
• Support routine maintenance, change requests, and release readiness efforts.
• Review audit findings, customer feedback, and implementation observations to identify opportunities for improvement.

Skills

Computer smart

Analytical thinking

Communication skills

Cross-functional collaboration

Education

Bachelor's degree in nursing

Job description

Availity delivers revenue cycle and related business solutions for health care professionals who want to build healthy, thriving organizations. Availity has headquarters in Jacksonville, FL, an office in Bangalore, India, and a nationwide remote workforce across the United States.

The UM Nurse Analyst (Clinical Informaticist) will translate payer medical policies into AI-enabled decision trees, validate clinical alignment, and support automated prior authorization workflows.