Clinical Informaticist Nurse

Job Summary

Working remotely in a full-time capacity, the Clinical Informaticist Nurse will interpret payer medical policy guidelines and construct AI-enabled decision trees to support automated prior authorization workflows while collaborating with cross-functional teams.

Key responsibilities

• Review payer medical policy guidelines to identify medical necessity criteria related to procedural codes
• Build and maintain decision pathways and recommendation logic that reflect payer requirements and clinical intent
• Provide clinical guidance to product operations and engineering teams regarding decision tree behavior and policy interpretation

Required qualifications

• Bachelor's degree in nursing
• At least 3 years of experience in a Utilization Management program or equivalent clinical experience
• Strong understanding of medical necessity criteria, payer medical policy, and prior authorization workflows
• Familiarity with CPT, HCPCS, ICD-10, and documentation requirements
• Ability to communicate clinical rationale to technical and operational stakeholders