Medical Review Institute of America, LLC

Medical Director

• As a Medical Director, you will use your clinical expertise to evaluate clinical service requests, interpret benefit language and medical policies, and render coverage determinations.
• Conduct clinical coverage reviews using member benefits and established clinical guidelines.
• Interpret benefit language and policies to support review determinations.
• Document review findings in accordance with regulatory, accreditation, and internal standards.
• Engage in peer-to-peer discussions with treating providers when needed.
• Collaborate with a nationwide team of Medical Directors.

Medical Director – Utilization Review

Artificial Intelligence

• This role is focused on translating proven ML research and existing algorithms into practical, scalable tools that improve operational efficiency, automate decisions, and enhance the internal and external customer experience.
• Translate business and clinical requirements into machine learning use cases focused on automation, decision support, and risk prediction in the utilization management domain.
• Adapt and optimize existing machine learning techniques—including classification, NLP, and time series modeling—to address specific operational workflows and data structures.
• Collaborate with developers to rapidly prototype and iterate on ML models with a focus on production readiness, scalability, and integration into customer-facing products.
• Contribute to the design of intelligent services (e.g., automated prior authorization, clinical rule learning, denial prediction) that directly impact product capabilities.
• Collaborate with data engineers to acquire, preprocess, and structure healthcare data from diverse sources (claims, EHR, clinical notes).
• Perform data wrangling and feature engineering to enable robust modeling pipelines.
• Evaluate and tune model performance using business-relevant metrics (e.g., precision, recall, F1, ROI), ensuring alignment with product goals and customer needs.
• Partner closely with product managers, designers, and software engineers to embed ML capabilities into digital products and decision support tools.
• Develop documentation, model APIs, and integration specifications to support seamless model deployment in production systems.
• Ensure ML solutions are reliable, maintainable, and explainable, supporting long-term operation in healthcare environments.
• Implement monitoring and retraining strategies to maintain performance and adapt to data drift.
• Stay up to date with emerging research in ML and health AI, identifying opportunities to apply new techniques pragmatically.

AI/ML Scientist, Healthcare

Sales

• Our VP of Sales is responsible for growing sales in excess of 20% annually through long-term planning and execution, along with building long-lasting relationships with Health Plans, Value-based providers, PBMs, TPA’s, Self-Insured Employers, and other healthcare payer organizations.
• Direct all lead generation and sales activities to impact new business growth and cross-selling at existing accounts to drive increased revenue.
• Direct end-to-end sales process for all product lines and services offered by the Company to drive new revenue growth and increase opportunities for core business expansion.
• Build and demonstrate in-depth understanding of MRIoA solutions and services.
• Be the industry expert for Peer-to-Peer Review sales into targeted market segmentation.
• Manage the entire end-to-end sales process, from lead generation to pipeline management through deal execution and enablement of implementation to meet or exceed the quarterly and annual sales quota.
• Maintain key client relationships and expand the current client portfolio.
• Build a territory plan by strategically targeting prospects and identifying opportunities that will lead to pipeline growth (e.g., email campaigns, cold calls, tradeshows, LinkedIn Sales Navigator, ZoomInfo, and working with inside sales and customer success).
• Prepare and perform all product demonstrations and presentations to key stakeholders.
• Collaborate with clinical support, product management, inside sales, and account management during the sales process and through handoff.
• Maintain up-to-date account information in Salesforce, including contacts, opportunities, and pipeline, with appropriate placement of opportunities by sales stage, revenue amount, and close date to ensure accurate forecast.

Vice President of Sales – Healthcare

• Responsible for growing sales in excess of 20% annually through long-term planning and execution.
• Build long-lasting relationships with Health Plans, Value-based providers, PBMs, TPA’s, Self-Insured Employers, and other healthcare payer organizations.
• Partner with customer success, clinical, and operations teams to focus on revenue growth, customer satisfaction metrics, and profitability.
• Direct lead generation and sales activities to impact new business growth.
• Manage the entire end-to-end sales process, from lead generation to pipeline management through deal execution and enablement of implementation.
• Maintain key client relationships and expand the current client portfolio.
• Prepare and perform all product demonstrations and presentations to key stakeholders.
• Collaborate with clinical support, product management, inside sales, and account management during the sales process.
• Provide feedback and input for marketing/product/service enhancements.

Vice President of Sales – Strategic Accounts

• Conduct coverage reviews using critical thinking and clinical expertise, based on individual patient/member benefits and national or proprietary coverage review policies.
• Interpret benefit language and policies to guide clinical coverage determinations.
• Document clinical review findings and outcomes in compliance with organizational, regulatory, and accreditation standards.
• Engage in peer-to-peer consultations with prescribing providers when appropriate.
• Collaborate and communicate effectively with fellow Medical Directors.

Utilization Review Medical Director

AI Engineer

• Lead design, development, and deployment of AI/ML solutions across the enterprise
• Collaborate with business, operations, and technology teams to define AI use cases and align delivery timelines
• Partner with internal teams and third-party vendors to develop efficient, compliant, and scalable AI systems
• Lead rapid prototyping efforts to demonstrate value and inform broader adoption
• Research, design, and implement machine learning models (supervised, unsupervised, reinforcement learning), including deep learning and NLP
• Conduct data preparation, cleansing, and feature engineering
• Train, validate, and fine-tune models to optimize performance and accuracy
• Build reusable, production-ready pipelines for AI model deployment using MLOps best practices
• Integrate AI/ML capabilities into existing products and platforms with application development teams
• Design and implement testing and evaluation frameworks for model validation; monitor and maintain deployed models
• Ensure AI systems are secure and compliant with regulatory standards (e.g., HITRUST, SOC 2, HIPAA)
• Support transition of business processes to AI-driven solutions with documentation, training, and retrospectives
• Work remotely from home using standard office equipment as required

AI Developer, Healthcare

• Translate business and clinical requirements into machine learning use cases focused on automation, decision support, and risk prediction in the utilization management domain
• Adapt and optimize existing machine learning techniques—including classification, NLP, and time series modeling—to address specific operational workflows and data structures
• Collaborate with developers to rapidly prototype and iterate on ML models with a focus on production-readiness, scalability, and integration into customer-facing products
• Contribute to the design of intelligent services (e.g., automated prior authorization, clinical rule learning, denial prediction) that directly impact product capabilities
• Collaborate with data engineers to acquire, preprocess, and structure healthcare data from diverse sources (claims, EHR, clinical notes)
• Perform data wrangling and feature engineering to enable robust modeling pipelines
• Evaluate and tune model performance using business-relevant metrics (e.g., precision, recall, F1, ROI), ensuring alignment with product goals and customer needs
• Partner with product managers, designers, and software engineers to embed ML capabilities into digital products and decision support tools
• Develop documentation, model APIs, and integration specifications to support seamless model deployment in production systems
• Provide insights and recommendations to support product roadmap decisions and feature prioritization
• Ensure ML solutions are reliable, maintainable, and explainable, implementing monitoring and retraining strategies to maintain performance and adapt to data drift
• Align development with healthcare compliance requirements (HIPAA, HITRUST, SOC 2) and promote ethical use of AI
• Stay up to date with emerging research in ML and health AI and conduct competitive analysis of commercial and open-source AI/ML tools
• Contribute to internal knowledge sharing and build a culture of applied innovation and product-driven development

AI/ML Scientist – Healthcare

Frontend Engineer

• Design, implement, test, document, and maintain software applications according to existing guidelines, coding standards, and industry best practices.
• Assist stakeholders in defining scope and specifications for new software solutions by studying business requirements, work processes, and data usage.
• Document, investigate, fix, and report on software defects.
• Monitor, analyze, refactor, and enhance existing apps and source code.
• Research and recommend improvements to our software, processes, and development tools, including cost and time estimates.
• Complete other duties as requested