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Availity

Where healthcare connects. Now Hiring!

Medical Director

Medical DirectorMedical DirectorFull TimeRemoteLeadTeam 1,001-5,000Since 2000H1B SponsorCompany SiteLinkedIn

Location

United States

Posted

3 days ago

Salary

Not specified

Seniority

Lead

Professional Certificate8 yrs expEnglish

Job Description

• 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

Job 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

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