Medical Director (Remote)

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.

Reporting to the VP of Software Engineering, the Medical Director will lead a team of UM RN Analysts responsible for producing Availity's Auth AI platform. Specifically, the Medical Director will provide input and oversight of the interpretation of payer medical policy guidelines, the construction of NLP/AI-enabled attestation trees reflective of the medical necessity criteria and clinical validation of the platform.

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 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

Role qualifications:

• MD/DO with at least 8 years of clinical experience.
• At least 5 years of experience in the healthcare revenue cycle roles including Utilization Management, prior authorization, claims appeals/denials, either with an insurer or with a healthcare provider.
• Prior experience working in healthcare information technology and with cross-functional teams, while not essential, will enhance an application.

You will set yourself apart:

• If you have a deep, working knowledge of the healthcare insurance industry and relevant state and federal regulations.
• If you have experience working or interacting with payer medical policy teams including experience performing peer-to-peer conversations or serving on medical policy committees.
• If you have exceptional critical thinking and reasoning skills.
• If you can synthesize complex, abstract problems and collaborate effectively with team members with diverse skillsets to create solutions.
• If you are self-motivated and a quick learner with an ability to multi-task.
• If you bring strong leadership and delegation skills to the table.
• If you still practice medicine, but share a passion for fixing a broken system.

What you will be doing:

• Providing oversight and input to the clinical team of UM nurses and prior authorization specialists throughout the product development process from the point of initial review of medical policy through the release of NLP/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.
• Ensuring effective flow of all tasks related to the delivery of medical policy creation including tree creation, labeling, and MD validation.
• Providing input to the NLP team to enhance validity and accuracy of the NLP outputs and to identify additional medical terms that should be added to the existing vocabulary of coded concepts.
• Occasionally serve as clinical liaison to the medical policy teams at current customers, including serving as non-voting member of their medical policy committees.

Availity culture and benefits:

• Availity is a certified "Great Place to Work", a "Best Workplaces for Technology Companies", a "Best Workplaces for Women" and a "Best Workplaces for Millennials"!
• Culture is important to us and there are many ways for you to make your mark here!
• We have several Diversity & Inclusion teams and various ways to engage with fellow Availity associates. "AvaiLadies", "Beyond Black", "HOLA", "Availity Pride", "VetAvaility" a Young Professionals Group and "She Can Code IT" a group for women in tech are some of the groups you can get involved in.
• 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!
• 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.
• Interested in wellness? We allow our associates to reimburse up to $250/year for gym memberships, participation in racing events, weight management programs, etc.
• Interested in furthering your education? We offer education reimbursement!
• Availity offers Paid Parental Leave for both moms and dads, both birth parents and adoptive parents.
• Want to work for an organization that gives back to the community? You're at the right place! Availity partners with various organizations, both locally and nationally, to raise awareness, funds and morale as our staff members volunteer their time and funds to engage the organizations campaign.

Next steps:

After you apply, you will receive text/email messages thanking you for applying and then you will continue to receive more text/email messages alerting you as to where you are in the recruitment process.

Interview process:

• Recruiter resume review
• Manager resume review
• Recruiter video interview
• Manager video interview
• Panel video interview

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.

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