Clinical Operations Specialist

Generator Health; United States; Remote; USD 28,000 - 52,000; Full time

Job summary

Generator Health is seeking a Remote, full-time Clinical Operations Specialist to safeguard the accuracy of our prior authorization process. You will review live queues, audit AI outputs, and help PQ workflow improvements while handling diverse clinical cases.

Ideal candidates bring 2+ years in prior authorization, strong notes literacy, and outstanding attention to detail. You will collaborate with product, engineering, and data science teams to advance patient access to treatment.

Qualifications

• 2+ years of hands-on experience in prior authorization or related roles.
• Strong familiarity with medical records and clinical notes.
• Ability to translate clinical complexity into actionable findings.
• Exceptional attention to detail and accuracy.

Responsibilities

• Review a live queue of prior authorization cases to ensure decisions meet standards.
• Audit AI outputs, third-party reviews, and internal decisions for accuracy.
• Flag errors and edge cases with clear documentation for the clinical intelligence team.
• Collaborate across product, engineering, and data science to refine workflows.
• Expand knowledge across medical specialties while handling diverse cases.
• Contribute to improving tools, standards, and processes for patient access.

Skills

Prior authorization

Clinical data

Auditing

Documentation

Cross-functional collaboration

Job description

This is a remote full-time hourly position. We are currently able to employ team members who live in the following states: Alabama, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Kansas, Louisiana, Maryland, Massachusetts, Michigan, Minneso ta, Mississippi, Missouri, Nevada, New Hampshire, New Jersey, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Virginia, Washington, Wisconsin. If you do not currently reside in or are actively relocating to one of these states, we unfortunately cannot consider your application at this time.

About the role

As a Clinical Operations Specialist at Generator Health, you will play a critical role in ensuring the accuracy and integrity of our system’s prior authorization process. You'll bring your expertise in clinical data understanding to catch errors, and uphold the standards that our patients and providers depend on.

This is a high-autonomy role where your attention to detail and ability to read, understand, and translate clinical data into results directly impacts patient access to treatment. Tens of thousands of patients move through our platform every week. You will work closely with our clinical intelligence team to support prior authorization, appeals, denial prediction and more. Your contributions will help us continuously improve the accuracy and reliability of our platform, whether decisions were made by AI, a third party, or our internal team.

If you join, you will:

• Review a live queue of prior authorization cases coming through the platform, ensuring every decision meets clinical and operational standards

• Audit AI outputs, third party reviews, and internal team decisions for accuracy, consistency, and compliance

• Flag errors and edge cases, documenting findings clearly for the clinical intelligence team

• Collaborate cross-functionally to surface patterns and help refine the workflows and logic that power our platform

• Expand your knowledge across medical specialties as you work across a diverse range of cases

• Contribute to improving the tools, standards, and processes that support patient access to treatment

We’ll be most excited if you have:

• 2+ years of hands-on experience in prior authorization, utilization management, clinical care coordination, scribing, or other roles that involve deep work with clinical documentation

• Strong familiarity with medical records and clinical notes, and comfort interpreting them accurately

• Strong written communication, with an ability to translate clinical complexity into clear, actionable findings for non-clinical teams

• Exceptional attention to detail and accuracy

• Comfort and/or a strong interest in collaborating with product, engineering, and data science teammates on building new technologies

Our salary ranges are based on a number of factors, including qualifications, experience level, and geography.

Generator Health is an equal opportunity employer and does not discriminate on the basis of race, gender, sexual orientation, gender identity/expression, national origin, disability, age, genetic information, veteran status, marital status, pregnancy or related condition, or any other basis protected by law.