Prior Authorisation AI Training Manager

About OpenTrain

OpenTrain is the #1 platform for finding and building careers in AI training and data labeling. OpenTrain AI is recruiting contractors to bring real-world healthcare expertise to the development of advanced AI systems.

• Create a free OpenTrain account and apply in minutes
• Build a professional profile focused on your AI training experience
• Find flexible opportunities that can support a long-term career in AI

About AI Training Work

AI training is the human side of building artificial intelligence. Experts review examples, evaluate model responses, and provide structured feedback so AI systems can become more accurate, useful, and responsible.

In this role, your clinical review experience will help assess whether AI-generated prior authorisation recommendations are accurate, appropriate, and supported by medical-necessity documentation.

• Work directly on cutting-edge healthcare AI development
• Apply professional judgment to model evaluation and feedback
• Contribute structured examples that help improve future AI outputs

The Role

OpenTrain is seeking an expert Prior Authorisation AI Training Manager to evaluate clinical prior authorisation workflows and AI-generated recommendations. You will review medical-necessity documentation, compare cases against InterQual, MCG, and payer-specific criteria, and annotate AI outputs with structured clinical feedback for training datasets.

The work also includes tracking authorisation outcomes, denials, and appeals while helping refine standard operating procedures and escalation processes for healthcare review operations. This is a US-based, part-time contractor role requiring 20+ hours per week, with pay of $105 per hour.

• Experience level: Expert
• Location: United States
• Language: English
• Engagement: Contractor and part time
• Time requirement: 20+ hours per week
• Pay: $105 per hour

What You'll Do

You will combine healthcare review expertise, operational leadership, and careful evaluation of AI-generated clinical content. Your feedback will support model improvement and stronger prior authorisation workflows.

• Review clinical documentation against medical-necessity criteria and payer rules
• Evaluate AI-generated prior authorisation recommendations and clinical justifications
• Coordinate approvals, denials, follow-ups, and appeals across clinical stakeholders
• Track KPIs including approval rates, turnaround time, and denial trends
• Annotate AI outputs with structured feedback for training datasets
• Help refine SOPs and escalation processes for healthcare review operations

Requirements

This role requires substantial experience in prior authorisation, utilisation management, or clinical review, including experience managing workflow operations. Strong written and verbal English communication and careful attention to detail are essential.

• 5+ years of experience in prior authorisation, utilisation management, or clinical review
• 2+ years of experience in a management role
• Knowledge of InterQual, MCG, or equivalent medical-necessity criteria
• Experience evaluating AI-generated clinical recommendations or documentation
• Familiarity with commercial, Medicare Advantage, and Medicaid workflows
• Strong written and verbal English communication skills
• Familiarity with authorisation management systems and EHR platforms such as Epic or Cerner
• Clinical licensure or relevant certification preferred, including RN, LPN, CPUR, or CPUM

Helpful Background

Candidates with experience across healthcare authorisation operations and clinical escalation processes may be especially well suited to this work.

• Experience with appeals and peer-to-peer review processes
• Familiarity with CMS prior authorisation rules
• Knowledge of the No Surprises Act
• Background in physician office, hospital, or health plan authorisation operations
• Experience with commercial, Medicare Advantage, and Medicaid prior authorisation requirements

Why This Work Matters

Every major AI system depends on high-quality examples prepared and reviewed by people. By assessing clinical reasoning, documentation, and payer criteria, healthcare professionals help shape AI systems that can better support complex real-world workflows.

• Use specialised healthcare knowledge in a fast-growing technology field
• Help improve the accuracy and appropriateness of clinical AI recommendations
• Choose flexible part-time work that can fit alongside other professional commitments

How to Apply Through OpenTrain

Create a free OpenTrain account, complete your profile, and apply for this opportunity in minutes. Highlight your prior authorisation, utilisation management, clinical review, leadership, and healthcare operations experience so your qualifications are easy to assess.

• Confirm that you meet the US, English-language, and 20+ hour weekly requirements
• Showcase relevant clinical credentials and certification
• Emphasise experience with payer criteria, appeals, EHRs, and AI evaluation
• Apply through OpenTrain to begin the review process