generatorhealth - Clinical AI Specialist (Remote)
Requirements
• This is a demanding role with a high level of autonomy and responsibility. You will be expected to act like an owner: prioritize effectively, surface problems early, and follow through until they’re resolved. If you are low-ego, hungry to learn, and motivated by consequential clinical work, we want to hear from you. • A Doctor of Pharmacy (PharmD) degree and 2–10 years of professional experience, including hands-on managed care work in prior authorization, utilization management, appeals, or clinical quality at a health plan, pharmacy benefit manager (PBM), or similar organization. • Excellent clinical reasoning: you can synthesize medical records, medication histories, payer criteria, and clinical evidence, work through ambiguity, and clearly explain a defensible conclusion. • Strong systems thinking: you look beyond individual errors to recognize recurring patterns, identify root causes, and improve how similar cases are reviewed. • Precise written communication and attention to detail, with the ability to provide structured feedback that makes the issue, its clinical significance, and the needed correction clear. • High ownership and strong execution: you work independently, prioritize effectively, and reliably deliver accurate work at high volume. • Excitement about working with and applying AI to clinical work, paired with intellectual curiosity, a willingness to experiment, and the judgement to challenge AI outputs and revise your own conclusions when the evidence warrants it. • Our salary ranges are based on a number of factors, including qualifications, experience level, and geography.
Responsibilities
• Audit a high volume of prior authorizations and AI-generated clinical outputs for accuracy, completeness, and alignment with the medical record and applicable payer criteria. • Apply evidence-based clinical reasoning to complex or ambiguous cases, distinguish clinically meaningful errors from minor issues, and help build a system that scales your expertise. • Identify recurring error patterns, gaps in clinical guidance, and edge cases; investigate their underlying causes and recommend improvements to review standards and workflows. • Apply AI tools to clinical review and auditing, critically evaluate their outputs, and identify ways to increase throughput while maintaining a high standard of clinical quality. • Own the quality and timeliness of your work, meet review expectations, and follow issues through to resolution.
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