Clinical Solutions Subject Matter Expert in Virginia Beach, Virginia at Commence

At Commence, we’re the start of a new age of data-centric transformation, elevating health outcomes and powering better, more efficient process to program and patient health. We combine quality data-driven solutions that fuel answers, technology that advances performance, and clinical expertise that builds trust to create a more efficient path to quality care.

With human-centered, healthcare-relevant, and value-based solutions, we create new possibilities with data. We provide proof beyond the concept and performance beyond the scope with a focus on efficiencies that transform the lives of those we serve. With a culture driven by purpose, straightforward communication and clinical domain expertise, Commence cuts straight to better care.

The Clinical Solutions Subject Matter Expert (SME) is a growth role that supplies the clinical grounding behind Commence’s federal health pursuits. The SME translates clinical and regulatory requirements and policy — how medical review, program integrity, and quality work is actually performed — into the functional requirements, workflows, and concepts of operations that shape our solutions.

The SME works alongside business development, capture, solution architects, and proposal staff to qualify opportunities, close intelligence gaps, and connect the clinical components of a solution to the technology that supports them.

• Provide clinical subject matter expertise across federal health pursuits, with emphasis on Medicare and Medicaid medical review, program integrity, quality improvement, and appeals/dispute resolution.
• Support opportunity research and qualification — assess the clinical scope of forecasted and active opportunities and advise on fit, feasibility, and staffing implications.
• Elicit and document functional requirements from solicitation documents, statements of work, agency engagements, and market research.
• Develop end-to-end operational workflows for target programs, including process steps, decision points, hand-offs, and the systems and data that support each step.
• Draft concept of operations (ConOps) content that describes how Commence would perform the work.
• Connect the clinical components of a solution — reviewer roles, coverage and coding determinations, quality assurance, inter-rater reliability, medical necessity criteria — to Commence’s technology and data capabilities.
• Partner with solution architects and technical staff to validate that proposed platforms, automation, and analytics reflect how clinical work is actually performed.
• Contribute clinical content and review to proposal volumes, technical approaches, staffing plans, and oral presentation materials.
• Support agency and stakeholder engagement, including capability briefings, industry days, and RFI responses.
• Identify and document open questions and intelligence gaps, and recommend the specific actions needed to close them.

Qualifications

• Active or previously held clinical license or credential (RN, LPN, or comparable), or equivalent depth of clinical operations experience.
• Minimum 8+ years of experience in healthcare operations, medical review, or program integrity, including experience supporting federal health programs.
• Working knowledge of Medicare fee-for-service coverage and payment rules, including local and national coverage determinations.
• Demonstrated experience translating clinical and regulatory requirements into documented processes, workflows, or procedures.
• Ability to work across clinical, technical, and business audiences and communicate clearly with each.
• Bachelor’s degree in a healthcare, business, or related field, or equivalent combination of education and experience.

Preferred Qualifications

• Direct experience in CMS program integrity or medical review programs and initiatives.
• Prior contribution to federal proposals, capture efforts, or solution development.
• Familiarity with health data platforms, workflow automation, or AI/ML applied to clinical review.

Work Environment/Physical Demands

The work environment and physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This is an office/remote position. While performing the duties of this job, the employee regularly works in a climate-controlled environment. Candidates must be able to sit, read, work on a computer, and watch a computer screen for extended periods of time. Occasionally required to stand, walk, use hands and fingers, kneel or crouch. This is a remote position. Candidates must be able to sit, read, work on a computer, and watch a computer screen for extended periods of time. Occasionally required to stand, walk, use hands and fingers, kneel or crouch. Commence is an equal employment opportunity employer. All personnel processes are merit-based and applied without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, marital status, age, disability, national or ethnic origin, military and veteran status or any other characteristic protected by applicable law. Commence.AI is committed to providing equal employment opportunities to all applicants, including individuals with disabilities. If you require a reasonable accommodation to participate in the application process due to a disability, please contact Human Resources at (757) 306-4920 or hr@commence.ai. Please note that unless you are requesting an accommodation, all applications must be submitted through our online application system.