Medical Review Institute of America, LLC

Medical Director

• Conduct utilization and medical necessity reviews using benefit language, medical policies, and evidence-based guidelines
• Apply benefit interpretation to ensure accurate, compliant, and well-supported determinations
• Prepare detailed documentation that meets regulatory, accreditation, and internal quality standards
• Participate in peer-to-peer conversations with treating clinicians when required
• Work collaboratively with Medical Directors across regions and specialties to support consistent clinical decision-making

Physician Reviewer – UM Medical Director

QA Engineer

• Define, implement, and continuously improve QA processes, standards, and best practices across on-prem and cloud environments (GCP & Azure)
• Evaluate testing frameworks and make recommendations for adoption.
• Establish testing methodologies aligned with Agile development and hybrid infrastructure
• Define quality metrics, KPIs, and reporting for test coverage, defect trends, performance benchmarks, and release readiness
• Ensure QA processes are fully integrated with development, deployment, and release workflows
• Oversee and coordinate QA activities performed by QA testers (onshore and offshore) and UAT testers
• Provide hands-on testing support when needed, including test execution, defect validation, and root-cause analysis
• Review and approve test plans, test cases, and defect reports
• Act as the primary liaison between Scrum Master, Development, Product, compliance, security and business stakeholders
• Design, develop, and maintain regression testing suites across all supported environments
• Define and implement end-to-end (E2E) testing covering frontend, backend, APIs, and integrations
• Own and execute performance testing strategies, including load, stress, and scalability testing
• Analyze performance test results and work with engineering teams to identify bottlenecks and improvements
• Ensure consistent behavior and performance across on-prem, GCP, and Azure deployments
• Define and manage test data strategies to support functional, regression, E2E, and performance testing across on-prem, GCP, and Azure environments
• Ensure availability of accurate, representative, and reusable test data for QA and UAT testing activities
• Coordinate creation, refresh, masking, and maintenance of test data to align with privacy, security, and compliance requirements
• Establish processes for test data versioning to ensure consistent test results across environments
• Collaborate with Engineering, Infra, and database teams to automate test data setup and teardown where possible
• Identify and mitigate test risks related to data dependencies, data quality, and data integrity
• Drive adoption and optimization of test automation frameworks for functional, E2E, and performance testing
• Manage QA workflows, defect tracking, and reporting using Jira
• Integrate automated testing into CI/CD pipelines for on-prem and cloud-based deployments
• Ensure proper management of test environments, test data, and environment parity
• Identify quality, performance, and environment-specific risks early in the release cycle
• Communicate quality status, performance metrics, and release readiness to stakeholders
• Support go/no-go release decisions with data-driven insights
• Lead root-cause analysis for production and pre-production defects

Quality Assurance Lead

Executive Assistant

• Provide support to the CEO and Executive Leadership Team
• Act as the company’s first-line representative to external constituents (i.e., Board members, private equity staff, etc.)
• Provide support to the Administrative Team and availability for back-up coverage as needed
• Serve as assistant to CEO: Prepare internal and external corporate documents for team members and industry partners throughout the Microsoft Office suite of products
• Proactively manage calendars of Officers by scheduling meetings and appointments and managing travel itineraries
• Prepare expense reports and reconcile Monitor incoming email requests and keep respective members of the leadership team apprised of important information
• Leverage technology to support the Officer during regular tasks (ex. note taker in meetings)
• Assist with ad-hoc large-scale projects from members of the Executive Leadership Team
• Maintain an organized filing system of electronic documents
• Interface with external business partners as needed by the Officer (ex. board members, private equity support staff, banking officials, etc)
• Manage projects and events from planning through delivery to ensure deliverables, requirements, schedules, costs, and meeting plans are properly tracked and communicated
• Uphold a strict level of confidentiality
• Responsible for time-sensitive and PII sensitive information
• Develop and sustain a level of professionalism among staff and clientele
• Assist the Administrative Team with duties and provide back-up support with scheduling
• Support all Quality Management initiatives as applicable
• Support all Compliance Program activities, including maintaining confidentiality and adhering to HIPAA guidelines
• Participate in all Company meetings and training as applicable
• Complete other duties and responsibilities as requested

Executive Administrator

• Define, implement, and continuously improve QA processes, standards, and best practices across on-prem and cloud environments (GCP & Azure)
• Evaluate testing frameworks and make recommendations for adoption.
• Establish testing methodologies aligned with Agile development and hybrid infrastructure
• Define quality metrics, KPIs, and reporting for test coverage, defect trends, performance benchmarks, and release readiness
• Ensure QA processes are fully integrated with development, deployment, and release workflows
• Oversee and coordinate QA activities performed by QA testers (onshore and offshore) and UAT testers
• Provide hands-on testing support when needed, including test execution, defect validation, and root-cause analysis
• Review and approve test plans, test cases, and defect reports
• Act as the primary liaison between Scrum Master, Development, Product, compliance, security and business stakeholders
• Design, develop, and maintain regression testing suites across all supported environments
• Define and implement end-to-end (E2E) testing covering frontend, backend, APIs, and integrations
• Own and execute performance testing strategies, including load, stress, and scalability testing
• Analyze performance test results and work with engineering teams to identify bottlenecks and improvements
• Ensure consistent behavior and performance across on-prem, GCP, and Azure deployments
• Define and manage test data strategies to support functional, regression, E2E, and performance testing across on-prem, GCP, and Azure environments
• Ensure availability of accurate, representative, and reusable test data for QA and UAT testing activities
• Coordinate creation, refresh, masking, and maintenance of test data to align with privacy, security, and compliance requirements
• Establish processes for test data versioning to ensure consistent test results across environments
• Collaborate with Engineering, Infra, and database teams to automate test data setup and teardown where possible
• Identify and mitigate test risks related to data dependencies, data quality, and data integrity
• Drive adoption and optimization of test automation frameworks for functional, E2E, and performance testing
• Manage QA workflows, defect tracking, and reporting using Jira
• Integrate automated testing into CI/CD pipelines for on-prem and cloud-based deployments
• Ensure proper management of test environments, test data, and environment parity
• Identify quality, performance, and environment-specific risks early in the release cycle
• Communicate quality status, performance metrics, and release readiness to stakeholders
• Support go/no-go release decisions with data-driven insights
• Lead root-cause analysis for production and pre-production defects
• Collaborate with IT/IS divisions to ensure adherence to security and data protection standards.
• Partner with Compliance to maintain conformity with state, federal, and healthcare-specific regulations.
• Coordinate with external development partners to ensure delivery quality and alignment with internal standards.

Quality Assurance Manager

Product Manager

• Partner with leadership to prioritize the project backlog based on VFOs, ROI, and organizational timelines.
• Act as the central hub for the BI team, managing work intake, developer assignments, and delivery schedules.
• Translate complex business needs into detailed technical specifications that developers can execute with minimal ambiguity.
• Work directly with the business to identify key performance drivers and recommend the best ways to visualize data for clear decision-making.
• Provide weekly status updates on VFO-aligned projects to applicable leadership and stakeholders.
• Communicate project health, risks, and milestones to ensure transparency across the leadership team.
• Own the Kanban/Jira board, ensuring all tasks are accurately documented, assigned, and moving through the development lifecycle.
• Maintain a clean and prioritized backlog, ensuring developers are always working on the highest-value tasks.
• Lead discovery sessions for new BI dashboards and workflows to define functional and technical requirements.
• Document "as-is" and "to-be" processes to ensure automation projects deliver the intended efficiency gains.
• Help the business to refine vague requests into specific data requirements, ensuring the final dashboards solve their operational problems.
• Collaborate daily with BI developers to estimate build timelines and manage resource capacity.
• Assist in managing off-shore development teams, providing clear tasking and ensuring accountability for assigned deliverables.
• Analyze incoming project requests against VFOs and current timelines to provide data-driven recommendations on prioritization and schedules.

Product Owner, Business Intelligence

Business Development Rep

• Responsible for participating in development and implementation of corporate wide marketing and sales activities
• Build funnel with leads for clinical review services in the health, pharmacy, third-party administrator, Taft- Hartley plans, employer self-insured, disability and worker’s compensation industries
• Partners with commercial sales and marketing teams to develop sales opportunities and grow funnel
• Assists Customer Success reps in developing strong customer relationships, meets and exceeds sales targets, and provides world-class customer support
• Partner with regional sales representatives to search out new sales opportunities through new clients or new opportunities with existing clients
• Assist in developing a business strategy to maximize opportunities for clinical service offerings in health, pharmacy and other specialty areas of focus
• Achieve sales target and funnel growth volumes
• Advance sales funnel opportunities

Business Development Representative, Healthcare

• Apply your clinical expertise to evaluate requests for medical services
• Interpret benefit language and medical policies
• Make sound coverage determinations
• Engage in peer-to-peer discussions with treating providers
• Perform clinical coverage reviews using member benefits, medical policies, and established clinical guidelines
• Document review outcomes in alignment with regulatory, accreditation, and internal standards
• Participate in peer-to-peer discussions with treating providers as needed
• Collaborate with Medical Directors across multiple specialties and regions

Medical Director – Physician Advisor

Chief of Staff

• The Chief of Staff (CoS) to the Chief Medical Officer is a pivotal leadership role that combines strategic advisory, operational oversight, and cross-functional coordination to maximize the CMO’s effectiveness.
• Partner closely with the CMO to define, refine, and execute the organization’s clinical strategy, ensuring alignment with the broader corporate mission and regulatory requirements.
• Conduct research, analyze data, and prepare strategic recommendations on emerging healthcare trends, clinical innovations, operational inefficiencies, and policy changes.
• Prepare financial and operational data analysis for senior leadership decision-making, including operational performance outcomes, analyzing and predicting spends for budgeting, and prediction analysis to make recommendations for future departmental needs.
• Develop high-quality briefing materials, executive summaries, and presentations for board meetings, leadership updates, and external engagements.
• Anticipate challenges and opportunities, providing the CMO with actionable insights to support informed decision-making.
• Oversee the planning, execution, and monitoring of key initiatives led by the CMO’s office, ensuring projects are delivered on time, within scope, and on budget.
• Establish and maintain systems for tracking progress on strategic goals, including dashboards, scorecards, and regular status updates.
• Coordinate with administrative, clinical, and operational leaders to ensure seamless execution of cross-departmental initiatives.
• Partner with Quality Management to support the design, implementation, and evaluation of clinical quality improvement programs and compliance efforts through operational process improvement.
• Collaborate with medical directors, other clinical resources, and quality teams to monitor performance metrics, identify gaps, and drive corrective actions.
• Assist in the implementation of new clients and programs.
• Ensure that all initiatives meet or exceed regulatory, accreditation, and ethical standards.
• Serve as a primary liaison between the CMO’s office and internal/external stakeholders, including employed and panel clinicians, executives, and Private Equity firm staff.