Clinical Review Specialist - Fully Remote | Upto $105/hr

Job Description

Job Description

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

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