Clinical Integrity Manager (Utilization Management)

Location: United States; fully remote with approximately 10% travel

Salary: $108,000–$125,000 annually, plus benefits and bonus

Company

hirify.global develops a clinical intelligence platform and AI-powered solutions that connect health plans and providers, supporting utilization management, prior authorization, payment accuracy, and clinical validation.

What you will do

• Review products, workflows, and clinical programs for evidence-based practice, regulatory compliance, and client alignment.
• Write clinical requirements, user stories, and acceptance criteria for utilization management workflows, clinical decision support, and AI-enabled capabilities.
• Represent clinical integrity in sprint planning and design sessions with Product and Engineering.
• Lead operational readiness through UAT, test scripts, defect documentation, release tracking, and client implementation support.
• Audit client commitments and SLAs, identify product gaps, and drive remediation.
• Build governance documentation, SOPs, playbooks, training materials, and clinical assessments for prospective clients.

Requirements

• Active, unrestricted clinical license as an RN, PT, OT, or SLP.
• Bachelor’s degree in Nursing, Therapy, Healthcare Administration, or a related field.
• 5+ years of progressive experience in Utilization Management, Clinical Operations, or health plan operations, including 2+ years in a leadership or supervisory role.
• Strong knowledge of Medicare Advantage, Medicaid, Commercial, and Marketplace utilization management, CMS regulations, NCQA accreditation, and delegation oversight.
• Experience partnering with Product and Technology teams to shape clinical workflows and digital solutions.
• Ability to write documentation, test workflows, build process tools, communicate across functions, and influence stakeholders without formal authority.

Nice to have

• Master’s degree.
• Experience with AI-enabled clinical workflows, InterQual®, or MCG®.
• Lean, Six Sigma, Agile, or project management certification.
• Prior UAT or QA experience in a technology environment.

Culture & Benefits

• Fully remote work with approximately 10% travel.
• Medical, dental, vision, life, disability insurance, and an Employee Assistance Program.
• 401(k) retirement plan with company match, flexible spending account, and health savings account.
• Flexible time off, company holidays, and up to 14 weeks of paid parental leave.
• Pet insurance and a supportive, inclusive, growth-oriented environment.

Hiring process

• Preliminary phone screening with Talent Acquisition.
• Interview with the hiring manager.
• Behavioral interviews.