Clinical Review Specialist - Fully Remote | Upto $105/hr
关于工作的职位，默科尔将精英创意和技术人才与领先的人工智能研究实验室联系起来。总部位于旧金山，我们的投资者包括 Benchmark,General Catalyst,Peter Thiel,Adam D'Angelo,Larry Summers 和 Jack Dorsey.职位：前授权经理类型：合同补偿：105美元/小时位置：远程角色责任 ·管理医疗和临床服务的端到端预期授权工作流程在多种付款类型中。·审查临床文档以评估对 InterQual,MCG 或付款人的特定标准的医学需求。· 评估人工智能生成的预先授权建议和临床证明草案以确定其准确性和合适性。· 与临床工作人员，医生和付款人协调获取及时许可证批准。· 追踪授权状况，拒绝以及上诉结果以识别工作流程改善机会。· 注释人工智能产品并提供结构化临床反来支持人工智能培训数据集。资格必须具有5年以上在事前授权，利用管理或临床审查方面的经验，至少2年担任管理职位。· 有强大的临床背景，了解医学必要性标准 （InterQual,MCG 或等级）. · 熟悉商业，医疗保险优惠和医疗补助预先授权要求。·经验管理多个专业类型和服务类型的授权工作流程。· 有能力使用授权管理系统和 EHR 平台 （Epic,Cerner 或相等）. · 特殊的书面和口头英语沟通技能。·高度关注细节，具有批判性评估临床文档和人工智能生成产品的能力。优先 • 临床许可证 （RN,LPN 或相等）或相关认证 (CPUR,CPUM). · 对上诉和同行审查过程的经验。·熟悉 CMS 预先授权规则和无意外法。·医生办公室，医院或健康计划的前期授权操作背景。·熟悉 AI 工具和评估人工智能生成的临床内容的舒适性。申请过程 （需要20~30分钟才能完成）·上传简历 ·基于简历的 AI 面试 ·提交表格资源与支持 ·详细了解面试进程和平台信息，请查看：·任何帮助或支持，联系以下号码：PS:我们的团队每天审查应用程序。请 co
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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:$105/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