Prior Authorisation Manager for AI Tool Evaluation

Help evaluate AI tools that streamline prior authorization workflows, using your clinical and utilization-management expertise to improve administrative efficiency and patient access to care.

• Manage end-to-end prior authorization workflows for medical and clinical services across multiple payer types.
• Review clinical documentation against InterQual, MCG, and payer-specific medical-necessity criteria.
• Assess AI-generated authorization recommendations and clinical-justification drafts for accuracy and appropriateness.
• Coordinate with clinical staff, physicians, and payers to secure timely approvals.
• Track authorization status, denials, and appeal outcomes to identify workflow improvements.
• Create and maintain standard operating procedures for submissions, follow-up, and escalations.
• Monitor approval rates, turnaround times, and denial rates.
• Maintain compliance with payer requirements, CMS guidance, and clinical review criteria.
• Annotate AI outputs and provide structured clinical feedback for training datasets.

• At least 5 years of experience in prior authorization, utilization management, or clinical review, including at least 2 years in a management role.
• Strong clinical background and knowledge of InterQual, MCG, or equivalent medical-necessity criteria.
• Deep familiarity with commercial, Medicare Advantage, and Medicaid prior authorization requirements.
• Experience managing workflows across multiple specialties and service types.
• Proficiency with authorization-management systems and EHR platforms such as Epic, Cerner, or equivalent tools.
• Exceptional written and verbal English communication skills.
• Strong attention to detail and the ability to critically assess clinical documentation and AI-generated outputs.

• RN, LPN, or equivalent clinical licensure, or CPUR or CPUM certification.
• Experience with appeals and peer-to-peer review processes.
• Familiarity with CMS prior authorization rules and the No Surprises Act.
• Experience in physician-office, hospital, or health-plan prior authorization operations.
• Comfort using AI tools and evaluating AI-generated clinical content.

• Remote, hourly engagement.

• $105 per hour.

• Contribute to advanced healthcare AI systems and gain exposure to AI workflows in revenue cycle management.
• Work on high-impact initiatives shaping the future of healthcare AI.