Remote

We are sharing a specialised part-time consulting opportunity for United States-based healthcare professionals experienced in prior authorization, utilization management, clinical review, medical necessity criteria, payer authorization workflows, documentation review, and healthcare operations.

This role supports current and upcoming remote consulting opportunities focused on AI-assisted prior authorization evaluation, clinical justification review, payer workflow assessment, and high-quality project execution. Selected professionals will apply clinical and authorization expertise to evaluate AI-generated prior authorization recommendations, review medical necessity documentation, identify workflow or compliance issues, and provide structured feedback based on detailed project criteria.

Key Responsibilities

Professionals in this role may contribute to:

Prior Authorization & Clinical Review

• Review end-to-end prior authorization workflows for medical and clinical services across multiple payer types
• Evaluate AI-generated prior authorization recommendations and clinical justification drafts for accuracy, completeness, and appropriateness
• Assess clinical documentation against InterQual, MCG, payer-specific criteria, or equivalent medical necessity standards
• Identify missing documentation, weak clinical rationale, incorrect payer logic, or unsupported authorization recommendations

Payer Workflow & Medical Necessity Evaluation

• Review workflows involving commercial, Medicare Advantage, Medicaid, and other payer authorization requirements
• Assess authorization status tracking, denial outcomes, appeal pathways, escalation processes, and turnaround time expectations
• Evaluate prior authorization workflows across multiple specialties, service types, clinical settings, and payer requirements
• Support review of KPIs such as authorization approval rates, turnaround times, denial rates, and workflow bottlenecks

Structured Clinical Feedback & Quality Control

• Annotate AI-generated prior authorization outputs and provide structured clinical feedback to support quality improvement
• Explain review decisions clearly, consistently, and with strong clinical and utilization management judgment
• Evaluate outputs for alignment with payer requirements, CMS guidance, clinical review criteria, and operational best practices
• Follow detailed task instructions, quality criteria, and project-specific review guidelines accurately

Ideal Profile

Strong candidates may have:

• 5+ years of experience in prior authorization, utilization management, clinical review, payer authorization, or related healthcare operations
• At least 2 years of experience in a management, team lead, supervisor, or operational oversight role
• Strong clinical background with knowledge of medical necessity criteria such as InterQual, MCG, or equivalent review standards
• Deep familiarity with commercial, Medicare Advantage, and Medicaid prior authorization requirements
• Experience managing authorization workflows across multiple specialties, payers, and service types
• Proficiency with authorization management systems and EHR platforms such as Epic, Cerner, or similar systems
• Exceptional written and verbal English communication skills
• High attention to detail and ability to critically evaluate clinical documentation and AI-generated outputs

Educational Background

• Professional background in prior authorization, utilization management, clinical review, nursing, healthcare operations, payer operations, medical necessity review, or care coordination is highly relevant
• Clinical licensure such as Registered Nurse, Licensed Practical Nurse, or equivalent clinical credential may be especially valuable depending on project scope
• Experience in physician office, hospital, health system, payer, managed care, or health plan prior authorization operations may support project fit
• Practical experience with EHR systems, authorization platforms, payer portals, clinical documentation review, and escalation workflows may be especially relevant

Nice to Have

• Clinical licensure such as Registered Nurse, Licensed Practical Nurse, or equivalent healthcare credential
• CPUR, CPUM, or similar utilization review or prior authorization certification
• Experience with appeals, denial review, peer-to-peer review processes, and payer escalation workflows
• Familiarity with CMS prior authorization rules, No Surprises Act considerations, and payer-specific authorization policies
• Exposure to healthcare technology, AI-assisted clinical tools, or structured annotation and review workflows
• Experience developing prior authorization SOPs, follow-up processes, escalation procedures, or workflow improvement plans

Why This Opportunity

• Apply prior authorization and clinical review expertise to structured remote healthcare project work
• Contribute to high-quality AI-assisted authorization workflow and medical necessity evaluation
• Use payer criteria knowledge, documentation review skills, and utilization management judgment in a focused review environment
• Work on flexible assignments aligned with clinical operations, prior authorization, payer workflows, and patient access expertise
• Remote structure with competitive hourly compensation

Contract Details

• Independent contractor role
• Fully remote with flexible scheduling
• United States-based professionals are required for this opportunity
• Part-time project-based commitment depending on availability, onboarding status, and project needs
• Competitive rates of up to $80 per hour depending on prior authorization experience, clinical background, management experience, and project scope
• Weekly payments via Stripe or Wise
• Projects may be extended, shortened, or adjusted depending on scope and performance
• Work will not involve access to confidential or proprietary information from any employer, client, or institution

About the Platform

This opportunity is available through 24-MAG LLC. We connect experienced professionals with remote consulting opportunities across technical, evaluation, and project-based workstreams.

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