Talent.com
Mercor
Remote Prior Authorisation Manager - AI Trainer ($105-$105 per hour)Mercor • Medford, Massachusetts, US
Remote Prior Authorisation Manager - AI Trainer ($105-$105 per hour)

Remote Prior Authorisation Manager - AI Trainer ($105-$105 per hour)

Mercor • Medford, Massachusetts, US
30+ days ago
Job type
  • Full-time
  • Remote
Job description
Mercor is working with a leading AI research lab to improve the capabilities of next-generation AI systems. We are seeking experienced Prior Authorisation Managers with clinical and medical expertise to support the evaluation of AI tools designed to streamline prior authorisation workflows. Your clinical knowledge of medical-necessity criteria, payer review processes, and utilisation management will help train AI systems to reduce administrative burden and improve patient access to care. **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. - Develop and maintain SOPs for prior authorisation submission, follow-up, and escalation processes. - Monitor KPIs including authorisation approval rates, turnaround times, and denial rates. - Ensure compliance with payer requirements, CMS guidelines, and clinical review criteria. - Annotate AI outputs and provide structured clinical feedback to support AI training datasets. **Requirements** - 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 Qualifications** - 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. **Why Join?** - Contribute to the development of frontier AI systems in healthcare. - Collaborate with a world-class AI research organisation. - Gain exposure to cutting-edge AI workflows in healthcare revenue cycle management. - Opportunity to work on high-impact projects shaping the future of healthcare AI.
Create a job alert for this search

Remote Prior Authorisation Manager - AI Trainer ($105-$105 per hour) • Medford, Massachusetts, US

Similar jobs

Forward Deployed Product Manager AI

Iterative HealthCambridge, MA, United States
Full-time

Forward Deployed Product Manager AI.Iterative Health is a healthcare technology and services company powering the acceleration of clinical research to improve patient outcomes.Through the Iterativ... Show more

 • Promoted

Remote AI Engineer Trainee

FOCUSKPI INCBoston, MA, United States
Remote
Full-time

Benefits :Flexible scheduleOpportunity for advancementTraining & developmentLocation :Remote in United States (EST Preferred)Type :Full-Time / Unpaid Trainee ProgramCompany :FocusKPIDO NOT CALL... Show more

 • Promoted

Remote Part-Time Survey Job – No Experience Needed, Up to $25 Each

Earn HausMiddleborough, MA, US
Remote
Full-time +1

We are urgently looking for people interested in taking online surveys for Fortune 500 brands.If you are a self-starter, looking for flexible hours throughout the week, this may be for you! Earn up... Show more

 • Promoted

Remote Physics Expert (Professor / Principal Investigator)

Micro1Middleborough Center, Massachusetts, US
$80.00 hourly
Remote
Full-time

Physics Expert (Professor / Principal Investigator).Expert Judgment in Ambiguous Cases.Defensible Written Articulation.AI data lab for training frontier models and evaluating AI agents.Experts cont... Show more

 • Promoted

Remote Product Tester - Flexible Studies

BuzzTestersRaynham, MA
Remote
Full-time

Earn up to $400/week, depending on the number and type of studies you complete.Share honest feedback on products and services from independent brands.Assignments include short online surveys (10–20... Show more

 • Promoted

Conversational AI and Agentic AI - Manager

PwC (US)Boston, MA, United States
Full-time

Conversational AI and Agentic AI - Manager.As a Conversational AI and Agentic AI - Manager, you will lead the charge in developing innovative user interaction solutions within our Advisory practice... Show more

 • Promoted

Flexible remote AI work. Your schedule. Paid weekly, straight to your bank account.

Meridian.aiPeabody, MA, US
Remote
Full-time

Review and label digital content including text, images, and documents.Every task you complete helps improve how technology interprets information and performs in practical settings.Detail-oriented... Show more

 • Promoted

Online Survey Taker. Earn up to $25 per survey. - Remote - Taunton

Earn HausTaunton, Massachusetts, United States
Remote
Full-time +1

We are urgently looking for people interested in taking online surveys for Fortune 500 brands.If you are a self-starter, looking for flexible hours throughout the week, this may be for you! Earn up... Show more

 • Promoted

Remote Statistics Expert (PhD)

Micro1Middleborough Center, Massachusetts, US
$90.00 hourly
Remote
Full-time

AI data lab for training frontier models and evaluating AI agents.Experts contribute their diverse subject matter knowledge across domains such as finance, healthcare, STEM engineering, and more.AI... Show more

 • Promoted

Remote Krita Expert

Micro1Brockton, Massachusetts, US
$20.00 hourly
Remote
Full-time

AI data lab for training frontier models and evaluating AI agents.Experts contribute their diverse subject matter knowledge across domains such as finance, healthcare, STEM engineering, and more.AI... Show more

 • Promoted

Enterprise AI Solutions Leader: Strategy, Governance & Delivery

Bausch & Lomb GmbHBridgewater, MA, United States
Full-time

Bausch & Lomb GmbH is looking for a Head of Enterprise AI Solutions in Bridgewater, Massachusetts.This role is responsible for the entire AI product portfolio, including strategy, delivery, and gov... Show more

 • Promoted

Remote Biology Expert

Micro1Taunton, Massachusetts, US
Remote
Full-time

AI data lab for training frontier models and evaluating AI agents.Experts contribute their diverse subject matter knowledge across domains such as finance, healthcare, STEM engineering, and more.AI... Show more

 • Promoted

Online Survey Taker. Earn up to $25 per survey. - Remote - Middleborough Center

Earn HausMiddleborough Center, Massachusetts, United States
Remote
Full-time +1

We are urgently looking for people interested in taking online surveys for Fortune 500 brands.If you are a self-starter, looking for flexible hours throughout the week, this may be for you! Earn up... Show more

 • Promoted

Remote Computer Science Expert (PhD)

Micro1Brockton, Massachusetts, US
$80.00 hourly
Remote
Full-time

AI data lab for training frontier models and evaluating AI agents.Experts contribute their diverse subject matter knowledge across domains such as finance, healthcare, STEM engineering, and more.AI... Show more

 • Promoted

AI Engineer Trainee (Remote)

FocusKPI Inc.Boston, MA, United States
Remote
Full-time

Location :Remote in United States (EST Preferred) Type :Full-Time / Unpaid Trainee Program Company :FocusKPI DO NOT CALL US.We only consider your application if you submit your resume and a brief c... Show more

 • Promoted

Remote Biology Expert (PhD)

Micro1Brockton, Massachusetts, US
$80.00 hourly
Remote
Full-time

AI data lab for training frontier models and evaluating AI agents.Experts contribute their diverse subject matter knowledge across domains such as finance, healthcare, STEM engineering, and more.AI... Show more

 • Promoted

Senior AI Startup Programs Manager (Remote)

DigitalOceanBoston, MA, United States
Remote
Full-time

A leading cloud solutions provider seeks a Senior Program Manager to oversee the startup application process, ensuring operational excellence and strategic thinking.Responsibilities include managin... Show more

 • Promoted

Online Survey Taker. Earn up to $25 per survey. - Remote - Abington

Earn HausAbington, Massachusetts, United States
Remote
Full-time +1

We are urgently looking for people interested in taking online surveys for Fortune 500 brands.If you are a self-starter, looking for flexible hours throughout the week, this may be for you! Earn up... Show more

 • Promoted

Online Survey Taker. Earn up to $25 per survey. - Remote - Avon

Earn HausAvon, Massachusetts, United States
Remote
Full-time +1

We are urgently looking for people interested in taking online surveys for Fortune 500 brands.If you are a self-starter, looking for flexible hours throughout the week, this may be for you! Earn up... Show more

 • Promoted

Online Survey Taker. Earn up to $25 per survey. - Remote - Middleborough

Earn HausMiddleborough, Massachusetts, United States
Remote
Full-time +1

We are urgently looking for people interested in taking online surveys for Fortune 500 brands.If you are a self-starter, looking for flexible hours throughout the week, this may be for you! Earn up... Show more