Remote | Clinical Prior Authorization Review Consultant — Up to $80/hour

24-Mag•New York, NY

14h•Remote

About The Position

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.

Requirements

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
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 Haves

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

Responsibilities

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
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
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