Clinical Integrity Manager
Core
Ensure clinical integrity, scalability, and operational readiness of a technology-enabled Utilization Management (UM) platform and clinical programs.
Role type
Manager, Clinical Integrity (hands-on operational leader)
Builds
Technology-enabled UM solutions, clinical decision support, and AI-enabled capabilities for health plans and providers
Domain
Healthcare / Utilization Management / Health Technology
Deliverable
production ML models | product features | dashboards & analysis
Required skills
Utilization Management (UM), clinical governance, regulatory compliance (CMS, NCQA), product lifecycle management, UAT, workflow optimization, cross-functional partnership
Preferred skills
AI-enabled clinical workflows, InterQual/MCG familiarity, Lean/Six Sigma/Agile/PM certification, UAT/QA in tech
Technologies
AI-enabled clinical solutions, InterQual, MCG
Responsibilities
Perform clinical reviews of product and workflows; write clinical requirements and acceptance criteria for UM and AI capabilities; execute UAT and build test scripts; audit client commitments and SLAs; build governance documentation and SOPs; partner cross-functionally on clinical integrity; support business growth with clinical assessments
Seniority
Manager, hands-on operational leader