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About the role
Key responsibilities & impact- Providing clinical leadership across Availity’s platform, including solutions that influence: Prior authorization, Utilization management, Clinical data exchange, Revenue cycle and administrative workflows connected to patient care
- Ensuring clinical logic, policies, and automation align with standards of care and payer medical policy frameworks
- Identifying and mitigating clinical, ethical, and reputational risk associated with scaled automation and AI-enabled workflows
- Partnering with Legal, Compliance, and Security teams on clinical governance and regulatory considerations
- Acting as the senior clinical partner to Product, Engineering, and Data Science
- Validating clinical assumptions embedded in business rules, analytics, and AI models
- Ensuring solutions are usable, defensible, and trusted in real provider and payer environments
- Serving as Availity’s primary clinical executive for enterprise customers
- Supporting payer medical leaders, provider executives, and clinical operations teams in adopting Availity solutions
- Partnering with Sales, Growth, and Customer teams in complex clinical discussions, evaluations, and implementations
- Defining clinical success criteria for solutions that support payer-provider interaction and decision-making
- Ensuring clinical claims are accurate, defensible, and supported by evidence or operational logic
- Supporting outcome measurement tied to efficiency, quality, and reduced friction in healthcare delivery
- Representing Availity as a credible, clinically grounded leader in the healthcare ecosystem
- Educating internal teams on how clinical practice, payer policy, and operational realities intersect
- Helping position Availity as a trusted, neutral intermediary in healthcare collaboration
Requirements
What you’ll need- Medical degree required (MD or DO)
- Extensive experience working with health systems and health plans
- Deep understanding of payer-provider workflows, clinical policy, and utilization management
- Experience partnering with technology, data, or analytics organizations at enterprise scale
- Strong executive presence and ability to influence without direct clinical operations ownership
- Background in health IT, healthcare networks, or enterprise healthcare platforms
- Experience with clinical decision support, utilization management, or AI-enabled healthcare workflows
- Familiarity with value-based care and population health models
- MBA, MPH, or clinical informatics experience
Benefits
Comp & perks- Competitive salary
- Bonus structure
- Generous HSA company contribution
- Healthcare benefits
- Vision and dental benefits
- 401k match program starting on day one
- Unlimited PTO for salaried associates + 9 paid holidays
- Up to 19 days of PTO for hourly associates
- Reimbursement for gym memberships, racing events, weight management programs, etc. up to $250/year
- Education reimbursement
- Paid Parental Leave for both moms and dads, birth and adoptive parents
- Opportunities for community engagement and volunteering
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
clinical decision supportutilization managementAI-enabled healthcare workflowsclinical data exchangerevenue cycle managementhealth IThealthcare networksenterprise healthcare platformspayer-provider workflowsclinical policy
Soft Skills
clinical leadershipexecutive presenceinfluencepartnershipcommunicationrisk mitigationeducational skillscollaborationdefensibilitytrust building
Certifications
MDDOMBAMPHclinical informatics