Prior Authorisation Manager

$105/hrrate as listed

Review AI-generated prior authorisation recommendations and clinical justification drafts against InterQual, MCG, and payer-specific medical-necessity criteria, then write structured feedback that becomes training data. Mercor lists this engagement at an observed rate of $105/hr, remote and largely async.

Summary, eligibility guidance and screening preparation are prepared by Sidequest from the platform's posting. Check the source listing before applying.

What the work involves

You will spend most of your time reading AI outputs the way you'd read a colleague's authorisation packet: does the clinical justification actually map to the documentation, does it cite the right criteria set, would this survive a payer review or land in denial? Typical tasks include grading AI-drafted medical-necessity letters, checking whether a model correctly identified that a service requires prior auth under a given plan type, flagging hallucinated criteria or misapplied InterQual/MCG subsets, and writing rubric-anchored rationales explaining exactly where the output failed. Some batches ask you to produce gold-standard reference answers — a clean authorisation submission or appeal argument — that models are then scored against.

The distinction that matters here is between reviewing and explaining. A rating without a defensible clinical rationale is close to worthless to the lab. Reviewers who do well tend to write feedback that a utilisation management trainer could act on: which element of the criteria was unmet, what documentation would have satisfied it, and why the payer type changes the answer.

What the platform screens for

Mercor's screen is AI-led and pushes on specifics. Expect follow-ups on the payer mix you actually worked, which criteria set your organisation licensed, how you handled peer-to-peer escalations, and turnaround-time standards you were measured against. Vague answers about "managing the auth team" get probed until they resolve into concrete cases or fall apart. The screen also tests evaluation judgment directly — you may be shown a plausible-sounding AI justification with a subtle criteria error and asked what you'd do with it.

5+ years in prior authorisation, utilisation management, or clinical review, with real management exposure
Fluency across commercial, Medicare Advantage, and Medicaid requirements — not just one book of business
Willingness to write, at length, in clear English

Logistics

Fully remote and asynchronous. Work is distributed in batches with deadlines rather than fixed shifts; most contributors commit 10–20 hours per week, and availability windows are negotiated per project. Engagements are contract-based and can taper or extend depending on the lab's data needs. The $105/hr figure reflects rates observed on this listing and is not a guarantee — final rates depend on credentials, screen performance, and project tier.

What they look for

5+ years in prior authorisation, utilisation management, or clinical review, including 2+ in a management role
Applied knowledge of InterQual, MCG, or equivalent medical-necessity criteria
Working fluency in commercial, Medicare Advantage, and Medicaid prior auth requirements
Clinical licensure (RN, LPN) or CPUR/CPUM certification
Experience with appeals and peer-to-peer review processes
Precise written English for structured evaluation feedback

Before you apply

Would you pass this screen?

Drawn from what this listing actually requires. Answered in your browser — nothing is sent to us, and we do not store your answers.

Do you have at least 5 years of professional experience in prior authorisation, utilisation management, or clinical review?
Prior authorisation experience · required
Of your prior authorisation or clinical review experience, have at least 2 years been in a management or lead role?
Management experience · required
Do you hold a clinical licence (RN, LPN, or equivalent) or a relevant healthcare certification (CPUR, CPUM, or similar)?
Clinical or medical credentials · preferred
Have you used authorisation management systems and at least one major EHR platform (Epic, Cerner, Athena, or equivalent) in a professional setting?
EHR and authorisation system proficiency · required
Have you managed prior authorisation workflows across at least two of the following payer types: commercial, Medicare Advantage, and Medicaid?
Multi-payer exposure · preferred

0 of 5 answered

Included with this listing

Interview prep — 12 questions

Matched to what this platform's screening actually measures. Answer each out loud in 60–90 seconds: claim → concrete example → implication.

What it tests: Whether you understand the clinical and administrative mechanics of denial: can you distinguish between clinical necessity gaps, documentation insufficiency, and payer policy misalignment, and do you know when to appeal versus resubmit.
A strong answer: A strong answer names a specific clinical criterion (e.g. length of stay, imaging protocol, drug tier), explains how the clinical record fell short of it, and describes a concrete next step (peer-to-peer, additional documentation, appeal under a different criterion).
Where people lose it: Candidates often describe a denial as purely bureaucratic friction rather than a legitimate clinical or documentation gap, suggesting they lack the medical rigour to evaluate AI outputs—or they describe chasing approvals without ever assessing whether the original request was clinically justified.