Prior Authorisation AI Training Manager

About OpenTrain

OpenTrain is the #1 platform for finding and building careers in AI training and data labeling. We help skilled reviewers and clinicians grow durable freelance careers teaching AI systems how to interpret real-world clinical data.

We connect experienced professionals to specialized AI-training projects, provide a unified profile for work history and certifications, and handle contracting and payment so contributors can focus on high-quality review and annotation.

Why AI Training Work Matters in Healthcare

AI training is the human side of building clinical AI: expert reviewers teach models what is medically appropriate by judging documentation, authorization decisions, and clinical reasoning. This work helps shape safer, more accurate healthcare tools while offering flexible, meaningful contract work.

Projects in this space reward clinical judgment, attention to detail, and domain experience — and contributors directly influence model behavior used in prior authorisation, utilization management, and care coordination.

Role Overview

OpenTrain is hiring a Prior Authorisation AI Training Manager to evaluate prior authorisation workflows and AI-generated recommendations for accuracy and appropriateness.

This is a US-based contractor, part-time role requiring 20+ hours per week. Compensation is hourly at USD $105. The role is aimed at experienced clinicians and prior-authorisation leaders with deep knowledge of payer rules and authorization workflows.

• Employment type: Contractor, Part-time
• Time requirement: 20+ hours/week
• Pay: $105 per hour (hourly)
• Location: United States (candidates must be based in the US)

What You’ll Do

You will review clinical documentation and AI recommendations, compare cases to evidence-based criteria and payer rules, and provide structured annotations that improve model performance and operational processes.

• Review clinical documentation against medical-necessity criteria such as InterQual and MCG and payer-specific rules.
• Evaluate AI-generated prior authorisation recommendations and clinical justifications for accuracy and appropriateness.
• Coordinate case outcomes including approvals, denials, follow-ups, and appeals with clinical stakeholders.
• Track KPIs like approval rates, turnaround time, and denial trends and surface patterns to improve models and SOPs.
• Annotate AI outputs with structured feedback for training datasets (label types include evaluation ratings and data collection).
• Help refine SOPs and escalation processes for healthcare review operations based on annotation insights.

Requirements

Candidates must demonstrate substantial prior authorisation and leadership experience, plus hands-on familiarity with payer criteria and authorization systems.

• Minimum 5 years in prior authorisation, utilisation management, or clinical review.
• At least 2 years in a management or leadership role overseeing workflow operations.
• Knowledge of InterQual, MCG, or equivalent medical-necessity criteria and payer-specific rules.
• Familiarity with commercial, Medicare Advantage, and Medicaid prior-authorisation workflows.
• Experience with authorization management systems and EHR platforms (examples: Epic, Cerner).
• Strong written and verbal English communication and attention to detail.
• Clinical licensure or relevant certification preferred (examples: RN, LPN, CPUR, CPUM).
• Experience evaluating AI-generated clinical recommendations or documentation.

Helpful Background

The following experiences are not required but will help you succeed and move models faster.

• Experience with appeals, peer-to-peer reviews, and denial management.
• Familiarity with CMS prior-authorisation rules and the No Surprises Act.
• Background in physician office, hospital, or health plan authorization operations and workflows.