CuraFi is a fast-paced healthcare technology startup helping providers, ACOs, RBOs, and payers improve utilization management, prior authorization workflows, specialty drug management, referral management, care coordination, and provider engagement.
We are looking for an experienced RN with strong critical thinking skills, with the ability to analyze clinical and operational decisions through both a business value and clinical integrity lens. This is a hybrid leadership and hands-on operations role. Approximately 50% of the role will involve direct review and processing of clinical cases, while the remaining time will focus on team oversight, workflow improvement, provider engagement, guideline development, and product collaboration.
Key Responsibilities
- Lead and manage a clinical operations team of pharmacists, RNs, and other clinical staff.
- Spend approximately 50% of time directly performing hands-on clinical operations work, including reviewing and processing medical records, claims, and lab/imaging results to determine diagnostic accuracy, UM cases, prior authorization requests, case reviews, provider outreach tasks, documentation checks, and guideline-based determinations.
- Critically analyze clinical, operational, and business tradeoffs to drive measurable value for CuraFi’s customers while maintaining clinical integrity, compliance, and patient-centered decision-making.
- Operational oversight over utilization management workflows, prior authorization reviews, case reviews, provider outreach, and network development activities.
- Support development and maintenance of clinical guidelines, utilization criteria, specialty drug policies, and clinical review protocols.
- Set up strategic communications and partnerships with providers, medical groups, payers, and internal teams to improve workflows, reduce administrative burden, and resolve case-level issues.
- Support network development efforts, including provider engagement, specialist routing, referral workflows, and performance improvement initiatives.
- Identify workflow gaps, operational bottlenecks, quality issues, and opportunities for automation or product improvement.
- Project manage and set up internal SOPs and obtain/keep current certifications such as NCQA, URAC accreditation
- Work closely with product, engineering, and leadership teams to translate clinical and operational needs into product requirements.
- Train, coach, and support clinical team members in a fast-changing startup environment.
- Track operational metrics, quality outcomes, SLA performance, provider response rates, and case review trends.
- Support audits, compliance reviews, documentation standards, and process improvement initiatives.
Ideal Candidate
- Active RN license.
- Experience in utilization management, prior authorization, case management, managed care, payer operations, ACO/RBO operations, or provider group operations.
- Strong understanding of Medicare, CMS requirements, specialty drugs, referrals, provider workflows, and clinical documentation.
- Experience managing or mentoring clinical teams.
- Comfortable reviewing complex clinical cases and applying medical policy or evidence-based criteria.
- Strong communication skills with providers, clinical staff, payers, and internal product/engineering teams.
- Able to move between strategy and execution: building processes while also jumping into day-to-day operational work.
- Highly organized, detail-oriented, and comfortable working in a fast-paced startup environment.
- Comfortable with technology, workflow tools, spreadsheets, clinical platforms, and AI-enabled clinical operations.
Preferred Qualifications
- Experience working with pharmacists or multidisciplinary clinical review teams.
- Experience with Medicare Advantage, Part B drugs, Part D drugs, specialty pharmacy, delegated UM, or provider network management.
- Experience developing clinical guidelines, medical policies, or utilization criteria.
- Prior startup, health tech, payer, MSO, IPA, ACO, or value-based care experience.
- Familiarity with NCQA, CMS ODAG/CDAG, HIPAA, audit readiness, and clinical quality processes.
Why Join CuraFi
This is a high-impact role for someone who wants to help build the clinical operating model for a growing healthcare startup. You will shape workflows, lead clinical teams, support provider-facing operations, influence product development, and directly improve how providers and payers manage complex care.
Pay: $140,000.00 - $160,000.00 per year
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Work Location: Remote
