Prior Authorisation Manager | $105/hr Remote
Overview
Elion Health is collaborating with a premier AI research lab to refine next-gen AI systems that automate prior authorization. We’re looking for a seasoned Prior Authorisation Manager who can bring real-world clinical and payer expertise to train these models. Your role will be to ensure AI-generated recommendations meet medical necessity standards, ultimately cutting administrative overhead and speeding up patient access to care.
What You'll Do8
- 1Oversee the full prior authorization lifecycle for a wide range of medical services across different payers, from submission to final decision.
- 2Analyze clinical documentation against established criteria like InterQual and MCG to validate medical necessity.
- 3Review AI-generated authorization recommendations and clinical justifications, providing feedback to improve model accuracy.
- 4Collaborate with physicians, clinical staff, and payer representatives to secure timely approvals and resolve denials.
- 5Track key metrics such as authorization turnaround times, approval rates, and denial patterns to pinpoint process bottlenecks.
- 6Create and maintain standard operating procedures for authorization workflows, follow-ups, and escalations.
- 7Ensure all activities comply with CMS guidelines, payer policies, and regulatory requirements.
- 8Annotate AI outputs and deliver structured clinical feedback to help train the underlying machine learning models.
Requirements6
- 1At least 5+ years of hands-on experience in prior authorization, utilization management, or clinical review, with a minimum of 2 years in a supervisory or management role.
- 2Strong clinical foundation and proven ability to apply medical necessity criteria such as InterQual, MCG, or payer-specific guidelines.
- 3Deep understanding of prior authorization requirements across commercial, Medicare Advantage, and Medicaid plans.
- 4Experience handling authorization workflows across multiple specialties and service types (e.g., surgery, imaging, inpatient).
- 5Proficiency with authorization management systems and EHR platforms like Epic or Cerner.
- 6Excellent written and verbal English communication skills, with high attention to detail when evaluating clinical documentation and AI outputs.
Who Should Apply
This role is ideal for a clinically minded manager who has spent years navigating the complexities of prior authorization and wants to apply that knowledge at the cutting edge of healthcare AI. You’re comfortable reviewing AI-generated content, giving precise feedback, and collaborating with both clinical teams and engineers. If you’re detail-oriented, process-savvy, and excited about shaping tools that could redefine revenue-cycle operations, this is your next move.
Salary Insight
The role pays $105.00 per hour on an hourly engagement basis.
Application Tip
When applying, highlight specific examples of how you’ve improved prior authorization turnaround times or reduced denial rates. Mention your familiarity with InterQual and MCG criteria explicitly, and share any experience you have evaluating or providing feedback on AI-generated outputs — even if informal.
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