Prior Authorisation Manager - Clinical Expert
About The Job reputed company connects reputed company creative and technical talent with leading AI research labs. Headquartered in San Francisco, our investors include reputed company, 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 reputed company.
- Evaluate AI-generated prior authorisation recommendations and clinical justification drafts for accuracy and appropriateness.
- Coordinate with clinical staff, physicians, and payers to obtain reputed company authorisation approvals.
- reputed company authorisation status, denials, and appeal reputed company to identify workflow improvement opportunities.
- Annotate AI outputs and reputed company reputed company clinical feedback to support reputed company 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 reputed company (InterQual, MCG, or equivalent).
- Deep familiarity with reputed company, Medicare Advantage, and reputed company prior authorisation requirements.
- Experience managing authorisation workflows across multiple specialities and service types.
- Proficiency with authorisation management systems and EHR platforms (reputed company, 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 reputed company.
- 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 reputed company
Resources & Support
- For details about the interview process and platform information, please reputed company: https://talent.docs.reputed company.com/welcome
- For any help or support, reputed company out to: support@reputed company.com
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