Prior Authorisation Manager
Mercor • Remote
Education
Any
Type
hourly
Pay Rate
$105/hr
Listed
36d ago
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About this Role
From the Mercor listing
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.
Requirements
- Must be eligible to work in Remote
- Fluent proficiency in English (Written & Verbal)
- Reliable high-speed internet connection
- Bachelor's degree or equivalent professional experience
- Demonstrated expertise in Business
Eligible Languages
Fluent proficiency in English
Key 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.
Why This Role
Few remote roles pay $105/hr for Business judgment on your own schedule. As a Prior Authorisation Manager, this is that role: real income, flexible hours, and direct exposure to how AI labs are building the next generation of models.
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Frequently Asked Questions
Is Mercor for freelancers or full-time contractors?
Mercor places you with one client for a defined engagement, like 'Python Tutor for 3 months', rather than having you grab small tasks from a shared queue. Most roles function as steady contract work, not one-off gigs.
Does Mercor's application require an on-camera interview?
Yes, every applicant records a video interview with an AI interviewer that asks questions about your resume. Clients review that recording to judge communication skills before matching, so there's no way to apply without going on camera.
Does it cost money to apply to Mercor?
No, applying and joining Mercor is free. Mercor's revenue comes from a fee it charges the client on top of your hourly rate, not from applicants. Treat any request for payment to join as a red flag.
Is AI training work the same as traditional consulting?
No. Instead of client deliverables, you're given complex scenarios to evaluate: grading the AI's logic, correcting its hallucinations, and supplying expert-level reasoning it doesn't have on its own. The job is closer to teaching than consulting.
Why do these AI training roles pay so much?
Because general knowledge isn't what's being tested. The model already knows the basics; what it needs is expertise on edge cases, the rare, difficult, highly technical judgment calls only a senior professional in the field would make correctly.
What does the day-to-day workload look like for elite-expert AI training roles?
Slow and deep, not fast and repetitive. A single task can take 45-60 minutes of researching citations or verifying complex calculations. Quality is what's being measured here, not throughput.
What does Business work look like for a Prior Authorisation Manager?
Tasks here are scoped to Business, not generic labeling. As a Prior Authorisation Manager, expect to draw on real domain judgment (evaluating outputs, correcting errors, or providing expert reasoning specific to Business) rather than following a one-size-fits-all rubric. If you don't have hands-on Business background, this is likely not the right listing to start with.
Do I need to be fluent in English?
Yes. This role specifically requires English proficiency. You will likely be evaluated on written fluency during the assessment, not just conversational level. If English is not your first language or you are not professionally fluent, this is not the right role. Filter for your native language to find better-matched listings.
What happens when I click Apply on this listing?
You'll be taken to Mercor's external site to complete your application there. This listing links through a referral, but the process is identical to applying directly; the link just routes you correctly. Create an account on their site and follow their onboarding steps.
How soon will I start working after applying to Mercor?
Not immediately. Mercor is a talent marketplace, not a task queue, so applying puts you in a pool of candidates. You start working only once a specific client, like a major AI lab, selects your profile, and that matching process can take weeks.