Clinical AI Scientist
Dubai - Relocation required.
We are looking for a Clinical AI Scientist with deep expertise in Utilization Management (UM) to join my clients innovative Data & AI team. This pivotal role bridges clinical operations and AI technology, focusing on validating and enhancing AI-driven solutions that support prior authorization, concurrent review, inpatient/outpatient adjudication, and medical necessity assessments within our health insurance platform.
If you have strong clinical experience combined with a passion for AI innovation, this is your chance to be a subject matter expert driving the accuracy, compliance, and continuous improvement of AI models that impact patient care and payer operations.
Key Responsibilities:
* Lead clinical validation of AI solutions integrated into utilization management workflows.
* Collaborate with data scientists and engineers to test AI models using real-world claims, clinical, and authorization data.
* Review and audit AI outputs (approval/denial recommendations, level-of-care classifications) against clinical guidelines and utilization standards.
* Develop and execute robust QA and UAT protocols to ensure clinical accuracy, sensitivity, and compliance.
* Analyze model performance, identify edge cases, and recommend data augmentation or retraining as needed.
* Support curation of medical knowledge bases and guideline repositories (e.g., MCG, InterQual, CMS LCD/NCD).
* Work closely with medical policy, case management, and prior authorization teams to integrate domain expertise into AI lifecycle.
* Document model assumptions, risk assessments, and validation reports to satisfy regulatory and audit requirements.
* Contribute to creation of clinical scenarios, test datasets, and annotations for supervised learning models.
* Act as a clinical ambassador ensuring AI solutions are explainable, safe, and user-friendly.
Qualifications:
* RN, MD, NP, PA, or equivalent advanced clinical degree required.
* Minimum 5 years' experience in Utilization Management, Prior Authorization, Case Review, or Medical Necessity Review within payer or health-tech environments.
* Basic proficiency with data science tools such as SQL, Python, and Excel.
* Experience supporting AI/ML model development or testing strongly preferred.
* Familiarity with EHRs, BRMS systems (e.g., Drools), and clinical decision support systems is a plus.
Soft Skills:
* Strong critical thinking and meticulous attention to detail.
* Excellent communication and documentation skills for effective collaboration across Data Science, Product, and Clinical teams.
* Passionate about advancing healthcare through ethical AI innovation.
Preferred:
* Prior experience in AI model validation, annotation, or testing in health insurance or digital health settings.
* Knowledge of evidence-based clinical guidelines and coding systems (ICD, CPT, DRG, HCPCS).
* Understanding of the UAE/MENA healthcare landscape and payer workflows is advantageous.