Seeking experienced patient financial services leaders to evaluate healthcare AI systems, improve self-pay collections, optimize patient payment plans, enhance financial engagement, and maximize revenue recovery while maintaining compliance and patient satisfaction.
Prior Authorisation Manager
United States
$150 – $150/hr
June 24, 2026
Job description
Role Overview
Mercor is partnering with a leading AI research laboratory to improve next-generation AI systems used in healthcare operations and utilization management.
The organization is seeking experienced Prior Authorization Managers with strong clinical and medical expertise to evaluate and improve AI tools designed to streamline prior authorization workflows, reduce administrative burden, and improve patient access to care.
Responsibilities
Prior Authorization Management
- Manage end-to-end prior authorization workflows across multiple payer types
- Coordinate submissions, follow-ups, escalations, and approvals
Clinical Review & Medical Necessity Assessment
- Review clinical documentation for completeness and appropriateness
- Assess medical necessity using InterQual criteria, MCG criteria, and payer-specific medical policies
AI Evaluation & Quality Review
- Review AI-generated prior authorization recommendations and clinical justification drafts
- Assess outputs for clinical accuracy, medical necessity alignment, payer appropriateness, and documentation quality
- Provide structured annotations and feedback to support AI training datasets
Performance Monitoring
- Track authorization approval rates, denial rates, turnaround times, and appeal outcomes
- Identify opportunities for workflow optimization and denial reduction
Requirements
- 5+ years of experience in Prior Authorization, Utilization Management, or Clinical Review
- Minimum 2 years in a management role
- Strong knowledge of InterQual, MCG, or equivalent utilization review frameworks
- Experience with Epic, Cerner, or equivalent EHR platforms
Preferred Qualifications
- RN, LPN, or equivalent clinical licensure
- CPUR or CPUM certification
- Experience with appeals management, peer-to-peer review, and CMS prior authorization regulations
Contract & Payment Terms
- Independent contractor engagement · Fully remote · Flexible schedule
- Weekly payments through Stripe or Wise
- US work authorization required · No visa sponsorship
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