Clinical Integrity Director

Location: Remote-first within the United States; approximately 10% travel, including possible travel to Boston, Massachusetts for onboarding and occasional in-person meetings and company events.

Salary: $159,000–$180,000 annually, plus benefits and bonus.

Company

hirify.global develops a clinical intelligence platform and AI-powered healthcare solutions that support payer-provider decision-making, utilization management, payment integrity, and clinical validation.

What you will do

• Own clinical integrity governance programs, including reviews, documentation, frameworks, checklists, tracking, and readiness dashboards.
• Manage clinical impact assessments for policy changes, product updates, and regulatory changes, escalating findings when needed.
• Manage the clinical requirements pipeline and translate regulatory and clinical changes into product specifications for Product and Engineering.
• Lead operational readiness for product releases and client implementations, tracking milestones, dependencies, and cross-functional accountability.
• Manage clinical UAT, including test assignment, results review, defect triage, and resolution before go-live.
• Prepare clinical integrity materials for RFPs, RFIs, and client questionnaires, and conduct feasibility assessments for prospective client requirements.

Requirements

• Active, unrestricted clinical license as an RN, PT, OT, or SLP.
• Bachelor's degree in Nursing, Therapy, Healthcare Administration, or a related clinical discipline.
• 7+ years of progressive experience in Utilization Management, Clinical Operations, or Health Plan operations, including 3+ years managing programs, projects, or teams.
• Strong knowledge of Medicare Advantage, Medicaid, Commercial, and Marketplace utilization management, CMS regulations, NCQA standards, and state regulatory requirements.
• Experience managing concurrent cross-functional workstreams involving Product, Engineering, and Operations in a technology-enabled environment.
• Strong organizational, communication, problem-solving, timeline management, and accountability-building skills.

Nice to have

• Master's degree in Healthcare Administration or Business Administration.
• Lean, Six Sigma, Agile, or PMP certification.
• Experience with clinical UAT programs, InterQual, MCG, or AI-enabled clinical workflows.

Culture & Benefits

• Remote-first work environment 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 and company holidays.
• Up to 14 weeks of paid parental leave and pet insurance.
• Inclusive, supportive, and growth-oriented environment centered on empathetic and collaborative work.

Hiring process

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