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Nurse Annotator (Prior Auth) Remote in US
2382416 At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together The Registered Nurse Clinical Annotator plays a critical role in supporting the development of artificial intelligence models designed to streamline and automate prior authorization processes in healthcare. This position leverages clinical expertise to interpret, annotate, and validate medical documentation, ensuring that AI systems are trained on accurate, contextually relevant, and policy-compliant data. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities:
- Review medical records and interpret clinical documentation with accuracy and clinical judgment
- Apply guideline-based criteria to annotate, categorize, and label case data used for AI model training
- Ensure annotations are clinically sound, consistent, and aligned with established utilization management (UM) guidelines
- Contribute to the development of high quality training datasets that support safe and effective AI model performance
- Identify gaps, ambiguities, or inconsistencies in documentation and escalate issues as needed
- Participate in refinement and continuous improvement of annotation guidelines, clinical rules, and workflows
- Collaborate with cross functional teams including data science, clinical operations, and product teams to ensure clinical accuracy and operational relevance of labeled data
- Support testing, validation, and quality review activities for AI supported UM tools and workflows
- Maintain detailed documentation of annotation decisions, rationales, and guideline interpretations
- Uphold clinical, ethical, and regulatory standards in all aspects of data handling, patient information, and annotation workflows
- Active, unrestricted RN license
- 3+ years of recent clinical experience in acute care, utilization management, or a related clinical specialty
- Experience applying guideline based criteria (e.g., InterQual, MCG) in clinical review or UM workflows
- Solid understanding of clinical documentation, medical terminology, and evidence-based practice
- Familiarity with HIPAA requirements, data privacy standards, and safe handling of patient information
- Proficiency with electronic medical records (EMR) and comfort navigating multiple clinical systems
- Proven ability to interpret medical records and determine clinical appropriateness using structured criteria
- Demonstrated experience performing payer-based clinical prior authorization reviews and medical necessity determinations for outpatient and inpatient procedures, advanced imaging, DME, specialty medications, infusion therapies, and other pre-service requests in accordance with health plan policy and evidence-based clinical criteria. Experience limited to provider-side authorizations, concurrent inpatient review, post-acute review, or discharge planning alone is not sufficient
- Proven ability to work independently while maintaining productivity, quality, and adherence to annotation guidelines
- BSN
- Experience collaborating with cross functional teams (clinical, data science, operations)
- Experience with data labeling, clinical data annotation, or AI/ML workflows
- Proven high level of accuracy, attention to detail, and commitment to consistent, high quality annotations
- Proven solid analytical thinking, clinical reasoning, and ability to identify gaps or inconsistencies in documentation
- Proven effective written communication skills, with the ability to clearly document annotation decisions and rationales
- Proven curiosity and willingness to learn emerging technologies, AI supported workflows, and evolving guidelines
- Integrity Value: Act Ethically
- Comply with Applicable Laws, Regulations and Policies
- Demonstrate Integrity
- Compassion Value: Focus on Customers
- Identify and Exceed Customer Expectations
- Improve the Customer Experience
- Relationships Value: Act as a Team Player
- Collaborate with Others
- Demonstrate Diversity Awareness
- Learn and Develop
- Relationships Value: Communicate Effectively
- Influence Others
- Listen Actively
- Speak and Write Clearly
- Innovation Value: Support Change and Innovation
- Contribute Innovative Ideas
- Work Effectively in a Changing Environment
- Performance Value: Make Fact-Based Decisions
- Apply Business Knowledge
- Use Sound Judgement
- Performance Value: Deliver Quality Results
- Drive for Results
- Manage Time Effectively
- Produce High-Quality Work
