Mercor logo
Mercor

Cincinnatus is an enterprise staffing company that partners with leading technology companies to source and employ highly skilled professionals for full-time and long-term contingent roles. Cincinnatus serves as the employer of record for these engagements, providing W-2 employment, payroll, benefits, and compliance, while placing employees directly within client teams to work on high-impact initiatives. Roles hired through Cincinnatus are not project-based or freelance engagements. They are structured, role-based positions that typically involve full-time or fixed-term commitments, close collaboration with a client's internal teams, and integration into standard enterprise workflows. Cincinnatus is a legal entity separate from Mercor. While opportunities may be discovered through Mercor's platform, employment, onboarding, payroll, and benefits for these roles are administered by Cincinnatus. Equal Employment Opportunity Cincinnatus is proud to be an Equal Employment Opportunity employer. We do not discriminate based upon race, religion, color, national origin, sex (including pregnancy, childbirth, reproductive health decisions, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, genetic information, political views or activity, or any other legally protected characteristic. Cincinnatus is committed to providing reasonable accommodations for qualified individuals with disabilities and disabled veterans throughout the job application process.

Prior Authorisation Manager

ManagerManagerPart TimeRemoteLeadH1B No Sponsor

Location

United States

Posted

1 day ago

Salary

$150 / hour

Seniority

Lead

No structured requirement data.

Job Description

Prior Authorisation Manager

Mercor

Role Description 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. - 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. Application Process - Upload resume - AI interview based on your resume - Submit form Resources & Support - For details about the interview process and platform information, please check: Interview Process - For any help or support, reach out to: support@mercor.com

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Manager1 day ago
Full TimeRemoteTeam 1,001-5,000Since 2013H1B Sponsor

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StackAdapt logo

Client Success Manager

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Manager1 day ago

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GitLab logo

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GitLab

Build software faster. The One DevOps Platform enables your entire org to collaborate around your code. We're hiring.

Manager1 day ago
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Nurturing our world and humankind by advancing care for animals

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