Medical Director
Availity
full-time
Posted on:
Location Type: Remote
Location: United States
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Job Level
About the role
- Lead a team of UM RN Analysts responsible for Availity’s Auth AI platform
- Provide input and oversight for interpretation of payer medical policy guidelines
- Construct NLP/AI–enabled attestation trees reflecting medical necessity criteria
- Perform complex tasks while collaborating with cross-functional teams
- Oversee clinical team throughout product development process
- Develop working knowledge of programming language and tools for automation
- Ensure effective flow of all tasks related to medical policy creation
- Serve as clinical liaison to medical policy teams at current customers
Requirements
- MD/DO with at least 8 years of clinical experience
- At least 5 years of experience in healthcare revenue cycle roles including Utilization Management, prior authorization, claims appeals/denials
- Prior experience in healthcare information technology (preferred)
- Deep knowledge of healthcare insurance industry and relevant state and federal regulations (preferred)
- Experience working with payer medical policy teams, including peer-to-peer conversations and medical policy committees (preferred)
- Exceptional critical thinking and reasoning skills
- Ability to synthesize complex problems and collaborate effectively
Benefits
- Competitive salary
- Bonus structure
- Generous HSA company contribution
- Healthcare benefits
- Vision benefits
- Dental benefits
- 401k match program available from day one
- Unlimited PTO for salaried associates + 9 paid holidays
- 19 days PTO for hourly associates, increasing with service
- Gym membership reimbursements up to $250/year
- Education reimbursement
- Paid Parental Leave for both moms and dads
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
NLPAIautomationmedical necessity criteriaclinical analysis
Soft Skills
critical thinkingreasoningcollaborationleadership
Certifications
MDDO