Clinical Intelligence
Core
Review AI-generated clinical outputs and prior authorizations for accuracy, completeness, and alignment with medical records and payer criteria to optimize clinical workflows.
Role type
Senior Clinical Intelligence Reviewer (AI Auditing)
Builds
Clinical guidance and quality standards for an AI-powered healthcare network
Domain
Healthcare operations + AI auditing
Deliverable
production ML models
Required skills
PharmD degree, managed care experience (prior authorization/utilization management), clinical reasoning, systems thinking, precise written communication, high ownership
Preferred skills
Experience with AI tools in clinical settings, ability to synthesize complex evidence, intellectual curiosity
Technologies
AI tools for clinical review and auditing
Responsibilities
Audit high volume of prior authorizations and AI-generated clinical outputs, apply evidence-based clinical reasoning to complex cases, identify recurring error patterns and recommend workflow improvements, evaluate AI tool outputs to increase throughput while maintaining quality, own the timeliness and accuracy of review work
Seniority
Mid-to-Senior, hands-on IC