Prior Authorisation Manager | $105/hr Remote
Overview
This remote role places you at the intersection of healthcare and cutting-edge AI. You'll apply your clinical expertise to help train next-generation AI systems that automate prior authorisation, reducing administrative friction and speeding up patient care. Working with a leading AI research lab, you'll evaluate AI-generated recommendations, review clinical documentation, and shape how these tools understand medical necessity. It's a unique chance to influence the future of healthcare AI while leveraging your deep knowledge of payer workflows.
What You'll Do9
- 1Own the full prior authorisation lifecycle for a variety of medical services across multiple insurance payer types, from initial submission to final decision.
- 2Review patient records and clinical notes to determine if they meet medical necessity standards using widely adopted criteria like InterQual or MCG, as well as payer-specific rules.
- 3Assess AI-generated authorisation recommendations and clinical justifications, flagging any inaccuracies or gaps to improve the system's performance.
- 4Collaborate with physicians, clinical staff, and payer representatives to speed up approvals and resolve any issues that could delay patient access.
- 5Keep close track of authorisation status, denials, and appeals, using the data to spot bottlenecks and suggest workflow improvements.
- 6Create and update standard operating procedures for submission, escalation, and follow-up to keep processes consistent and compliant.
- 7Track key performance metrics—such as approval turnaround times, denial rates, and approval rates—to measure and improve efficiency.
- 8Stay aligned with payer requirements, CMS guidelines, and clinical review standards, ensuring every decision is defensible and compliant.
- 9Provide structured feedback on AI outputs and annotate data to help train and refine the AI models used in prior authorisation.
Requirements7
- 1At least five years of hands-on experience in prior authorisation, utilisation management, or clinical review, with a minimum of two years in a supervisory or management capacity.
- 2A solid clinical foundation, including working knowledge of medical necessity frameworks such as InterQual, MCG, or similar standardised criteria.
- 3Deep understanding of prior authorisation requirements for commercial insurance, Medicare Advantage, and Medicaid, including the nuances of each payer type.
- 4Proven ability to manage authorisation workflows across multiple specialties and service lines, balancing competing priorities effectively.
- 5Hands-on proficiency with authorisation management systems and electronic health records, especially Epic, Cerner, or comparable platforms.
- 6Excellent written and verbal communication skills in English, with the ability to explain clinical decisions clearly to both medical and non-medical stakeholders.
- 7Sharp attention to detail and the ability to critically evaluate complex clinical documentation alongside AI-generated recommendations.
Who Should Apply
This role is perfect for a seasoned prior authorisation professional who's not only expert in the operational side but also excited about AI's potential to transform healthcare. You're comfortable digging into clinical details, have managed teams or workflows, and are open to evaluating and guiding AI outputs—not just processing requests. If you've worked in physician offices, hospitals, or health plans and want to apply your knowledge to frontier technology, this is your opportunity.
Salary Insight
The role pays $105 per hour on an hourly, remote engagement basis.
Location
Required Skills
Application Tip
Highlight your hands-on experience with specific criteria sets like InterQual or MCG, and be sure to mention any exposure to AI tools or clinical data annotation—even if it was in an exploratory or project-based capacity.
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