Forus
Clinical Intelligence
$120K–$240K
New York office · Full-time · Posted Jul 8, 2026
- Experience
- 2–10 years of professional experience.
- Education
- Doctor of Pharmacy (PharmD) degree.
About the job
Review prior authorizations and AI-generated clinical outputs, identify quality issues and recurring patterns, and improve clinical guidance and workflows.
What you'll do
- Audit prior authorizations and AI-generated outputs for accuracy, completeness, and alignment with medical records and payer criteria.
- Analyze complex cases and recurring errors, then recommend improvements to clinical guidance, review standards, and workflows.
- Use and evaluate AI tools to improve review throughput while maintaining clinical quality.
What they ask for
- PharmD degree.
- Hands-on managed care experience in prior authorization, utilization management, appeals, or clinical quality at a health plan, PBM, or similar organization.
- Excellent clinical reasoning and ability to communicate clear, structured clinical feedback.
- Ability to work independently, prioritize, and deliver accurate work at high volume.
Pay
$120K – $240K (base salary)
Tools
AI
AI focus
Use AI tools in clinical review and auditing, evaluate AI-generated outputs, and help improve model quality and review throughput.
Model-written summary · the original posting is authoritative