Medical Director, Clinical Informatics

Job not on LinkedIn

🔥 0 minutes ago

🇺🇸 United States – Remote

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

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Availity

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2000

🏥 Healthcare

💼 Consulting

📦 Logistics

💰 Secondary Market on 2021-07

Healthcare • Consulting • Logistics

Availity is a leading health information network that connects payers, providers, and technology partners in the healthcare industry. By facilitating over 13 billion clinical, administrative, and financial transactions annually, Availity streamlines payer-provider collaboration and enhances patient care through an integrated provider engagement platform. The company's solutions leverage artificial intelligence and interoperability to automate processes such as prior authorizations, revenue cycle management, and payment accuracy, ultimately reducing costs and improving efficiency across the healthcare ecosystem.

📋 Description

• Report to the Chief Medical Officer • Support delivery of content forming Availity’s clinical knowledge base for clinical decision support tools • Interpret external clinical content, including medical policies, clinical guidelines, and reimbursement policies • Oversee construction and maintenance of AI-enabled attestation trees • Provide clinical validation of the platform • Support development of additional use cases and customer interactions • Collaborate cross-functionally with Product, Engineering, and Clinical Informatics teams • Provide oversight and input throughout product development from initial medical policy review through production release of AI-enabled attestation trees • Assign coded medical constructs to attestation trees using a domain-specific programming language and development tools • Guide clinical oversight for teams building and maintaining clinical content attestation questions, decision pathways, and recommendation logic • Complete assigned tasks related to clinical decision support tool delivery, including decision tree creation, clinical concept labeling, and clinical performance validation • Review audit findings, customer feedback, and implementation observations to identify decision tree improvements • Enhance the validity and accuracy of AI outputs and identify additional medical terms for the coded concept vocabulary • Contribute thought leadership, clinical design, and operational support to innovation initiatives, including alpha/beta customer support • Support product enhancements and feature development • Advise Product, Engineering, implementation, sales, and account teams on decision tree behavior, policy/guideline interpretation, and clinical workflow considerations • Occasionally serve as clinical liaison to customer medical policy and utilization management teams • Occasionally serve as a non-voting member of customer medical policy committees

🎯 Requirements

• MD/DO • At least 8 years of clinical experience • 5+ years of experience in 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 • Prior experience working with cross-functional teams • In-depth knowledge of utilization management principles • Knowledge of the purpose and function of medical necessity guidelines • Knowledge of prior authorization adjudication practices • 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 • Experience learning, using, and optimizing a variety of technology and tooling • Ability to develop a working knowledge of a domain-specific programming language and use development tools • Exceptional critical thinking and reasoning skills • Strong analytic reasoning skills • Excellent communication and organizational skills • Ability to synthesize complex, abstract problems and collaborate with team members with diverse skillsets • Self-motivated, quick learner, and able to multitask • Must be able to use a camera for all virtual meetings • Must pass a drug test before beginning employment • Must satisfy U.S. employment eligibility verification requirements • Sponsorship is not available

🏖️ Benefits

• Competitive salary • Bonus structure • Generous HSA company contribution • Healthcare benefits • Vision benefits • Dental benefits • 401k match program available on day one • Unlimited PTO for salaried associates • 9 paid holidays • Wellness reimbursement of up to $250/year for gym memberships, racing events, weight management programs, etc. • Education reimbursement • Paid Parental Leave for birth and adoptive parents • Culture teams and Young Professionals Group • Pop-up lunches near Jacksonville when teams are in the office • Continuous learning resources and experts • Casual dress, including jeans • Remote-first work environment • Camera/video capability provided for associates • Community volunteering and charitable engagement opportunities