Managing process variability enable the process model adaptability according changes in the application environment. In the healthcare area, flexibility is essential to provide a quality treatment because, even patients with the same diagnostic, may follow different paths and suffer different proceedings. Besides, there are many aspects to be considered for the selection of a path, as patient’s symptoms, and clinical guidelines, among others. In this context, this research presents a framework for the management of the process variants through semantic reasoning. The enrichment of the business process with semantics enables the automation of the configuration, thus promoting more flexible and adaptive solutions. The proposed framework helps selecting the appropriate process variant according the patient’s symptoms by reasoning on ontologies based known expertise. In our specific use case, we will use the expertise of the Brazilian guideline for acute ischemic stroke.