Prior Authorisation Manager

About this role

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 au