Why work at OpTech?
OpTech is a woman-owned company that values your ideas, encourages your growth, and always has your back. When you work at OpTech, not only do you get health and dental benefits, but you also have training opportunities, flexible/remote work options, growth opportunities, 401K and competitive pay. Apply today! To view our complete list of openings, pleas e visit our website at www.optechus.com.
JOB SUMMARY:
We are seeking a Clinical Informatics / Clinical AI Specialist to bridge clinical expertise, data science, and operational workflows within a health insurance environment. This role ensures that AI-driven tools and analytics are clinically sound, operationally effective, and aligned with payer strategies such as population health, care management, utilization management, and quality improvement.
The ideal candidate brings hands-on clinical experience and a strong understanding of how AI and data-driven tools can support better member outcomes, cost efficiency, and regulatory compliance.
JOB RESPONSIBILITIES:
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Serve as the clinical subject matter expert for AI, analytics, and decision-support initiatives.
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Translate clinical and operational needs into AI use cases, requirements, and workflows.
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Partner with data scientists and ML engineers to guide model development, validation, and clinical relevance.
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Evaluate AI outputs for clinical accuracy, safety, bias, and interpretability.
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Support AI initiatives related to risk stratification, utilization management, prior authorization, care management, and quality metrics.
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Collaborate with care management, utilization review, and medical policy teams to integrate AI into daily workflows.
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Assist with clinical validation, documentation, and governance for AI models.
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Support training and change management for clinical and operational users.
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Ensure compliance with HIPAA, CMS regulations, and internal clinical governance standards.
JOB QUALIFICIATIONS:
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Active clinical license (RN, MD, DO, PharmD, NP, PA, or equivalent).
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3+ years of clinical experience in payer, provider, or care management settings.
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Experience working with clinical data, decision-support tools, or healthcare analytics.
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Strong understanding of clinical workflows, utilization management, and care coordination.
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Ability to collaborate effectively with technical and non-technical stakeholders.
- Comfortable translating between clinical language and technical concepts.
PREFERRED QUALIFICIATIONS:
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Experience in clinical informatics, health informatics, or digital health.
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Exposure to AI, machine learning, or predictive analytics in healthcare.
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Familiarity with claims data, EHR data, and payer analytics.
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Knowledge of HEDIS, CMS Star Ratings, risk adjustment, or value-based care.
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Experience supporting AI governance, validation, or model oversight.
- Prior involvement in AI implementation, optimization, or clinical workflow redesign.
OpTech is an equal opportunity employer and is committed to creating a diverse environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, pregnancy, status as a parent, disability, age, veteran status, or other characteristics as defined by federal, state or local laws. https://www.optechus.com/eeo_self_identification/