Medical Workflow Specialist - Fully Remote | Upto $150/hr
About the job
Mercor connects elite creative and technical talent with leading AI research labs. Headquartered in San Francisco, our investors include Benchmark , General Catalyst , Peter Thiel , Adam D'Angelo , Larry Summers , and Jack Dorsey .
Position: Prior Authorisation Manager
Type: Contract
Compensation: $150/hour
Location: Remote
Role Responsibilities
- Manage end-to-end prior authorisation workflows for medical and clinical services across multiple payer types.
- Review clinical documentation to assess medical necessity against InterQual , MCG , or payer-specific criteria.
- Evaluate AI-generated prior authorisation recommendations and clinical justification drafts for accuracy and appropriateness.
- Coordinate with clinical staff, physicians, and payers to obtain timely authorisation approvals.
- Track authorisation status, denials, and appeal outcomes to identify workflow improvement opportunities.
- Annotate AI outputs and provide structured clinical feedback to support AI training datasets .
Qualifications
Must-Have
- 5+ years of experience in prior authorisation, utilisation management, or clinical review, with at least 2 years in a management role.
- Strong clinical background with knowledge of medical necessity criteria ( InterQual , MCG , or equivalent).
- Deep familiarity with commercial, Medicare Advantage , and Medicaid prior authorisation requirements.
- Experience managing authorisation workflows across multiple specialities and service types.
- Proficiency with authorisation management systems and EHR platforms ( Epic , Cerner , or equivalent).
- Exceptional written and verbal English communication skills.
- High attention to detail with the ability to critically evaluate clinical documentation and AI-generated outputs .
Preferred
- Clinical licensure ( RN , LPN , or equivalent) or relevant certification ( CPUR , CPUM ).
- Experience with appeals and peer-to-peer review processes.
- Familiarity with CMS prior authorisation rules and the No Surprises Act .
- Background in physician office, hospital, or health plan prior authorisation operations.
- Familiarity with AI tools and comfort evaluating AI-generated clinical content .
Application Process (Takes 20–30 mins to complete)
- Upload resume
- AI interview based on your resume
- Submit form
Resources & Support
- For details about the interview process and platform information, please check:
- For any help or support, reach out to:
PS: Our team reviews applications daily. Please complete your AI interview and application steps to be considered for this opportunity.
Originally posted on Himalayas