Clinical Solutions Subject Matter Expert

Location: Fully remote in the United States; Virginia Beach is listed in the conditions.

Salary: $160K annually

Company

hirify.global develops data-driven healthcare solutions that combine clinical expertise, technology, and quality-focused processes to improve healthcare outcomes and efficiency.

What you will do

• Provide clinical expertise for federal health pursuits, particularly Medicare and Medicaid medical review, program integrity, quality improvement, and appeals.
• Research and qualify opportunities by assessing clinical scope, feasibility, fit, and staffing implications.
• Translate solicitation documents, statements of work, agency engagements, and market research into functional requirements and documented workflows.
• Develop end-to-end operational workflows and concepts of operations covering process steps, decisions, hand-offs, systems, and data.
• Connect clinical activities such as reviewer roles, coverage determinations, quality assurance, and medical necessity criteria to technology and data capabilities.
• Support proposals, capture efforts, agency briefings, industry days, RFI responses, and stakeholder engagement.

Requirements

• Active or previous clinical license or credential, such as RN or LPN, or equivalent clinical operations experience.
• 8+ years of experience in healthcare operations, medical review, or program integrity, including federal health programs.
• Working knowledge of Medicare fee-for-service coverage and payment rules, including local and national coverage determinations.
• Experience translating clinical and regulatory requirements into documented processes, workflows, or procedures.
• Ability to communicate effectively across clinical, technical, and business audiences.
• Bachelor’s degree in healthcare, business, or a related field, or an equivalent combination of education and experience.

Nice to have

• Direct CMS program integrity or medical review experience.
• Experience contributing to federal proposals, capture efforts, or solution development.
• Familiarity with health data platforms, workflow automation, or AI/ML applied to clinical review.

Culture & Benefits

• Fully remote office/work environment.
• Work focused on human-centered, healthcare-relevant, and value-based solutions.
• Purpose-driven culture emphasizing straightforward communication and clinical domain expertise.
• Reasonable accommodations are available for individuals with disabilities.