- Company Name
- Salt
- Job Title
- AI Scientist
- Job Description
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**Job Title:** Clinical AI Scientist
**Role Summary:**
Leads clinical validation and quality assurance of AI-driven utilization management solutions for a health insurance platform. Bridges clinical expertise with data science to ensure AI models deliver accurate, compliant, and explainable recommendations for prior authorization, concurrent review, and medical necessity assessments.
**Expectations:**
- Minimum 5 years experience in Utilization Management, Prior Authorization, or Medical Necessity review within payer or health‑tech settings.
- Advanced clinical degree (RN, MD, NP, PA, or equivalent).
- Ability to collaborate with data scientists, engineers, and policy teams; strong critical thinking, detail orientation, and communication skills.
- Commitment to ethical AI and continuous improvement of model performance.
**Key Responsibilities:**
- Lead clinical validation of AI models in UM workflows; audit AI outputs against clinical guidelines.
- Develop and execute QA and UAT protocols; document validation results, risk assessments, and compliance reports.
- Analyze model performance, identify edge cases, and recommend data augmentation or retraining.
- Curate and maintain medical knowledge bases (e.g., MCG, InterQual, CMS LCD/NCD).
- Create clinical scenarios, test datasets, and annotations for supervised learning.
- Serve as clinical ambassador to ensure AI solutions are explainable, safe, and user‑friendly.
- Collaborate with medical policy, case management, and prior‑authorization teams throughout the AI lifecycle.
**Required Skills:**
- Clinical expertise in utilization management and medical necessity review.
- Basic proficiency with SQL, Python, and Excel; familiarity with EHR, BRMS (e.g., Drools), and CDSS a plus.
- Knowledge of evidence‑based guidelines and coding systems (ICD, CPT, DRG, HCPCS).
- Strong analytical, documentation, and cross‑functional communication abilities.
**Required Education & Certifications:**
- Advanced clinical degree (RN, MD, NP, PA, or equivalent).
- No specific certification required, but certifications in health informatics, data science, or related fields are advantageous.