Senior Prior Authorization Lead - AI-Driven Healthcare

Mercor; San Francisco (CA); On-site; USD 150,000 - 190,000; Full time

Job summary

Mercor is partnering with a leading AI research lab to enhance AI-driven prior authorisation workflows for medical services. We are seeking experienced Prior Authorisation Managers with clinical expertise to train AI systems on medical-necessity criteria and payer review processes to reduce administrative burden and improve patient access.

Respondents will manage end-to-end authorisation workflows, review clinical documentation against criteria such as InterQual or MCG, coordinate with

Qualifications

• 5+ years of experience in prior authorisation or utilisation management, with at least 2 years in a management role.
• Strong clinical background with knowledge of medical necessity criteria.
• Experience with commercial, Medicare Advantage, and Medicaid authorisation requirements.

Responsibilities

• Manage end-to-end prior authorisation workflows for medical and clinical services across multiple payer types.
• Review clinical documentation against InterQual, MCG, or payer criteria.
• Evaluate AI-generated recommendations 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.

Skills

Prior authorization management

Clinical review

Utilisation management

Stakeholder collaboration

Quality & detail orientation

English communication

Education

RN license

CPUR/CPUM certification

Tools

Epic

Cerner

Job description

Mercor is partnering with a leading AI research lab to enhance AI-driven prior authorisation workflows for medical services. We are seeking experienced Prior Authorisation Managers with clinical expertise to train AI systems on medical-necessity criteria and payer review processes to reduce administrative burden and improve patient access.

Respondents will manage end-to-end authorisation workflows, review clinical documentation against criteria such as InterQual or MCG, coordinate with