[Hiring] Clinical Review Specialist @Mercor

Role Description

The Prior Authorisation Manager will be responsible for managing 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.
• Annotate AI outputs and provide structured clinical feedback to support AI training datasets.

Qualifications

• Must-Have: 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: 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.

Company Description

Mercor connects elite creative and technical talent with leading AI research labs. Headquartered in San Francisco, our investors include Benchmark, General Catalyst, Peter Thiel, Adam D'Angelo, Larry Summers, and Jack Dorsey.