Prior Authorisation Manager

Elion Health; United States; On-site; USD 90,000 - 120,000; Full time

Benefits offered by this job

Contribute to frontier AI systems in healthcare

Collaborate with a leading AI research organization

Exposure to cutting-edge AI workflows in healthcare revenue cycle management

Job summary

Elion Health is seeking an experienced Prior Authorisation Manager to oversee end-to-end workflows for medical services. This role requires strong clinical expertise in medical necessity criteria and excellent communication skills to collaborate effectively with various stakeholders.

The ideal candidate will have a minimum of 5 years of experience in prior authorisation or clinical review and will actively contribute to improving AI workflows in healthcare. This position offers the opportunity to work on impactful healthcare projects.

Qualifications

• 5+ years of experience in prior authorisation and clinical review.
• In-depth knowledge of medical necessity criteria.
• Experience managing authorisation workflows across multiple specialities.

Responsibilities

• Manage end-to-end prior authorisation workflows.
• Review clinical documentation for medical necessity.
• Coordinate with clinical staff and payers for authorisation approvals.

Skills

Prior authorisation management

Clinical knowledge

Communication skills

Attention to detail

Familiarity with EHR platforms

Education

5+ years experience in prior authorisation or clinical review

Clinical licensure or relevant certification

Tools

Epic

Cerner

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.