Job#:2230 - senior healthcare interoperability architect
Job Description:
We are seeking a Senior Healthcare Interoperability Architect to lead the design and implementation of CMS-0057-compliant interoperability solutions. This role focuses on integrating FHIR-based prior authorization capabilities with core utilization management (UM) systems, specifically platform environments like HealthEdge GuidingCare. You will design robust API architectures that convert FHIR requests/responses into seamless workflows for authorization intake, clinical decisioning, status tracking, and provider communications.
Key Responsibilities
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Architectural Leadership: Design and execute scalable, CMS-0057-compliant interoperability and integration architectures for payer prior authorization workflows.
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FHIR & Da Vinci Integration: Lead technical implementations utilizing FHIR R4 and Da Vinci Implementation Guides (CRD, DTR, PAS) to enable automated prior authorization processes.
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Platform & Data Translation: Map and translate FHIR payloads to integrate directly with UM platforms (GuidingCare, HealthRules) and enterprise core systems.
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End-to-End Workflow Management: Ensure technical architecture supports full-lifecycle authorization processes, including intake, clinical review, decisioning, and real-time status management.
Required Qualifications
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Overall Experience: 8+ years in healthcare technology, solution architecture, or systems integration.
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FHIR Expertise: 4+ years of direct, hands-on experience with HL7 FHIR R4.
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Implementation Guides: Deep knowledge and practical execution of Da Vinci CRD, DTR, and PAS.
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Payer & UM Platforms: Proven experience with payer workflows and utilization management tools (HealthEdge GuidingCare, HealthRules, or similar).
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Regulatory Knowledge: Solid understanding of CMS-0057-F mandate requirements and healthcare interoperability regulations.
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Technical Skills: Mastery of REST APIs, healthcare data models, terminology standards, and enterprise integration patterns.
