3401-UM Nurse Reviewer

Innovaccer is a leading healthcare technology company. We’re pioneering the Data Activation Platform that’s helping Big Data and the Healthcare industry realize the promise of value-based care.

We are looking for a Utilization Management (UM) Nurse Reviewer to bring clinical expertise into our AI-powered prior authorization workflows. This role is responsible for ensuring that our AI- powered prior authorization workflow reflects evidence-based and payer-specific guidelines. The ideal candidate will have broad experience across multiple specialties and payer policies, with strong utilization management and prior authorization expertise. This role blends clinical judgment with hands-on review of AI outputs to improve accuracy and alignment with payer criteria.

Apply clinical judgment to ensure outputs align with payer requirements, evidence-based guidelines, and coding standards. Monitor payer updates and guideline changes; ensure payer knowledge base remains current. Collaborate with product, engineering, and AI teams to translate clinical and utilization review requirements into actionable design. Test, validate, and refine AI-powered workflows to improve completeness, reduce denials, and ensure usability. Provide feedback loops to enhance knowledge base structure, clinical decision support, and automation quality. Stay current on payer requirements, clinical guidelines, regulatory standards, and coding updates relevant to utilization management.