Clinical Solutions Architect deploys an AI clinical reasoning platform into health plans. Maps real-world nurse/MD workflows, translates policies and guidelines into engineering requirements, configures and tests solutions, and advises clinical leadership on utilization management and prior authorization processes. Requires clinician background (RN/NP/MD) plus health plan operations experience.
Salary not listed
RemoteSolutions Architecture
About the role
Responsibilities
Own the clinical design of deployments end-to-end, from workflow discovery through configuration, testing, and go-live. Define what "clinically correct" means and maintain that standard.
Translate clinical reality (medical policy, guideline sets, nurse workflows, MD escalation rules) into clear, buildable requirements and acceptance criteria for engineering.
Map undocumented workflows by sitting with nurses and creating process diagrams to identify integration points for the AI platform.
Deeply understand utilization management, prior authorization, guideline sets, lines of business, delegated entities, and upcoming regulations through onsite customer work.
Deliver fast proofs of concept by configuring the platform to demonstrate clinical value early.
Act as a trusted advisor to customer clinical leaders, helping them identify true needs and optimal solutions.
Requirements
Clinician background: RN, BSN, NP, PA, or MD.
Experience working inside a health plan or delegated entity, with deep knowledge of intake, eligibility, network checks, medical review, and differences across lines of business.
Strong background in utilization management (preferred); adjacent experience in risk adjustment, HEDIS, care management, or appeals is valued.
Structured thinker with natural ability for intuitive workflow mapping, clean processes, and clear written communication (e.g., building training materials or SOPs).
Enjoy being in front of customers and building lasting relationships with clinical counterparts.
Genuine interest in AI, with proactive exploration of how these systems work and opinions on appropriate clinical trust boundaries.
Nice-to-Haves
Experience building training materials or SOPs for teams.
Views on where AI should or shouldn't be trusted with clinical judgment.
Compensation and Benefits
Competitive, top-of-market salary.
100% covered health, dental, and vision insurance.
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