Position Title
Registered Nurse (RN) Clinical Annotator - Prior Authorization AI Program
Position Overview
We are seeking an experienced Registered Nurse (RN) Clinical Annotator to support the development and advancement of artificial intelligence solutions designed to streamline prior authorization and utilization management processes. In this fully remote role, you will leverage your clinical expertise to review medical records, interpret clinical documentation, apply evidence-based criteria, and annotate healthcare data used to train and validate AI models. The ideal candidate will have a strong background in utilization management, prior authorization, case management, or acute clinical care and possess exceptional attention to detail, clinical judgment, and documentation review skills.
Schedule & Work Details
- Location: Fully Remote
- Schedule: Monday-Friday
- Weekly Hours: Full-Time
- Pay Rate: $40.00-$42.00/hour
- Patient Care Setting: Non-Patient Facing Clinical Review
- Resource Type: Non-IT Contractor
Key Responsibilities
- Review medical records and interpret clinical documentation with accuracy and sound clinical judgment.
- Apply guideline-based criteria to annotate, categorize, and label clinical data used for artificial intelligence model training.
- Ensure annotations are clinically accurate, consistent, and aligned with utilization management and prior authorization guidelines.
- Support the development of high-quality datasets used to improve AI-driven prior authorization workflows.
- Identify missing information, documentation gaps, inconsistencies, and ambiguities within medical records and escalate concerns when appropriate.
- Participate in quality assurance activities, data validation reviews, and annotation audits to maintain high-quality standards.
- Collaborate with clinical, operational, product, and data science teams to improve annotation processes and clinical workflows.
- Assist with the refinement of annotation guidelines, clinical decision rules, and workflow processes.
- Maintain detailed documentation supporting annotation decisions, clinical rationale, and guideline interpretations.
- Uphold HIPAA, privacy regulations, and organizational policies related to patient information and data security.
- Contribute to testing and validation efforts for AI-supported utilization management and prior authorization tools.
Required Qualifications
- Active, unrestricted Registered Nurse (RN) license.
- Associate Degree in Nursing required; BSN preferred.
- Minimum of 3 years of recent experience in acute care, utilization management, case management, prior authorization, or a related clinical specialty.
- Experience performing clinical reviews and applying medical necessity criteria.
- Strong understanding of medical terminology, clinical documentation, and evidence-based practice.
- Experience utilizing InterQual, MCG, or similar guideline-based review criteria.
- Ability to review medical records and determine clinical appropriateness using structured guidelines.
- Proficiency navigating electronic medical records and multiple healthcare technology platforms.
- Strong analytical thinking, critical reasoning, and problem-solving skills.
- Excellent written communication and documentation skills.
- Ability to work independently while maintaining productivity, quality, and consistency standards.
- Knowledge of HIPAA requirements and healthcare data privacy regulations.
Preferred Qualifications
- BSN degree.
- Prior authorization or utilization management experience across multiple service lines, including medical/surgical procedures, diagnostic imaging, durable medical equipment (DME), specialty therapies, and related services.
- Experience collaborating with multidisciplinary teams, including clinical, operational, and technical stakeholders.
- Previous experience with clinical data annotation, data labeling, AI-assisted healthcare workflows, or machine learning initiatives.
- Strong interest in healthcare technology, artificial intelligence, and process innovation.
- Leadership, mentoring, or quality review experience.
Key Skills
- Medical Record Review
- Clinical Documentation Analysis
- Prior Authorization
- Utilization Management
- InterQual & MCG Criteria
- Clinical Data Annotation
- Quality Assurance
- Clinical Decision Making
- Electronic Medical Records (EMR)
- Data Validation
- Healthcare Compliance
- Cross-Functional Collaboration
Additional Information
- Work Environment: Fully Remote
- Professional Certification Required: Active RN License
- Industry Focus: Healthcare Technology, Artificial Intelligence, Utilization Management, Prior Authorization
- Compensation: $40.00-$42.00 per hour
#LI-JG2
For workers in the United States, PrideGlobal and it's affiliates offers eligible employee’s comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, pet insurance and employee discounts with preferred vendors.
Equal Employment Opportunity
PrideGlobal and it's affiliates are an equal opportunity employer. We do not discriminate on the basis of the race, religious creed, color, national origin, ancestry, physical disability, mental disability, reproductive health decision making, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, veteran or military status, or any other characteristic protected by applicable federal, state, or local law.
Fair Chance Employment
PrideGlobal and it's affiliates are a Fair Chance employer. We consider all qualified applicants, including those with criminal histories, in a manner consistent with applicable state and local Fair Chance laws and ordinances, including, the California Fair Chance Act and all applicable local Fair Chance ordinances.
Accommodations
We are committed to providing reasonable accommodations to applicants and employees with disabilities. If you require a reasonable accommodation to participate in the application or interview process, or to perform the essential functions of this role, please contact us.
Only applicable for San Francisco Candidates: Under the San Francisco Lactation in the Workplace Ordinance, we will provide written notice of lactation accommodation rights, and this notice will automatically be given upon hiring, any inquiry of parental leave or lactation accommodation.
Only applicable for Kentucky positions: For this type of employment, state law requires a criminal record check as a condition of employment. This applies to direct care staff (Examples: RN, LPN, Nurse Aides, Therapists) referred to Kentucky nursing facilities, assisted living communities, or long-term care facilities, in accordance with KRS 216.793.
