Medical Director (Remote)

📋 Description

• • As the Medical Director at Availity, you will play a pivotal role in shaping the future of healthcare technology by leading a team of UM RN Analysts. Your primary responsibility will be to oversee the development and refinement of Availity’s Auth AI platform, a cutting-edge solution designed to streamline and automate prior authorization processes.
• • This leadership position requires a deep understanding of utilization management principles, the critical function of medical necessity guidelines, and the intricacies of prior authorization adjudication practices. You will be instrumental in interpreting complex payer medical policy guidelines, translating them into actionable logic for our AI platform.
• • A key aspect of your role will involve guiding the construction of NLP/AI-enabled attestation trees. This means ensuring these trees accurately reflect medical necessity criteria and are clinically validated, forming the backbone of our automated authorization system.
• • You will collaborate closely with a multidisciplinary team, bridging the gap between clinical expertise and engineering innovation. This collaborative environment demands strong analytical reasoning skills and the ability to communicate complex clinical concepts to technical colleagues.
• • Your day-to-day will involve providing direct oversight and input to your team of UM nurses and prior authorization specialists throughout the entire product development lifecycle. This includes initial review of medical policies, development of the attestation trees, and final validation before release into production.
• • You will gain a working knowledge of a domain-specific programming language and utilize development tools to assign coded medical constructs to attestation trees, thereby facilitating the automation of responses and decision-making processes.
• • Ensuring the effective flow of all tasks related to medical policy creation is paramount. This includes meticulous attention to tree creation, accurate labeling, and thorough MD validation to maintain the integrity and accuracy of the platform.
• • You will provide crucial input to the NLP team to enhance the validity and accuracy of their outputs. This involves identifying additional medical terms that should be incorporated into the existing vocabulary of coded concepts, continuously improving the platform's intelligence.
• • In certain instances, you will serve as a clinical liaison to the medical policy teams of our current customers. This may involve participating as a non-voting member of their medical policy committees, offering Availity's expertise and gaining valuable insights into industry best practices.
• • The ideal candidate will be detail-oriented, possess exceptional analytical reasoning skills, and demonstrate excellent communication and organizational abilities. A mindset that embraces change, fosters innovation, and remains open to new ideas is essential for success in this dynamic role.
• • This position offers a unique opportunity to leverage your extensive clinical background in a technology-driven environment, directly impacting the efficiency and effectiveness of healthcare operations nationwide.
• • You will be a key contributor to Availity's mission of bringing the focus back to patient care by simplifying administrative burdens for healthcare professionals.
• • Your leadership will directly influence the development of a platform that processes billions of transactions annually, connecting millions of providers to health plans and driving positive change in the healthcare ecosystem.
• • This role is ideal for a physician who is passionate about improving the healthcare system and seeks to apply their medical expertise in a transformative technological setting.
• • You will be part of a certified “Great Place to Work” organization, recognized for its commitment to innovation, diversity, and employee well-being.
• • The remote nature of this position offers flexibility and the opportunity to work from anywhere within the United States, contributing to a global team united by a powerful mission.
• • You will be empowered to make a significant impact, with your ideas celebrated and innovation actively encouraged.
• • This role is critical in solving complex communication challenges within the healthcare industry and creating connections that empower the nation's premier healthcare ecosystem.