Clinical AI Specialist (Remote)

As a member of the Clinical AI Specialist team at Generator Health, you will use your managed care expertise to optimize the quality, accuracy, and efficiency of AI models and clinical workflows. You will own the review of all clinical artifacts the system produces, using AI tooling to build a view of accuracy that combines clinical context, payer requirements, and regulatory compliance. This is a hands-on role centered on clinical review, structured feedback, and iterative improvement, with a high level of autonomy and responsibility.

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, distinguishing clinically meaningful errors from minor issues; Identify recurring error patterns, gaps in clinical guidance, and edge cases, 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 high clinical quality; Own the quality and timeliness of work, meet review expectations, and follow issues through to resolution; Help build the clinical guidance used by models and clinical teams to continuously improve system outputs

Requirements

Doctor of Pharmacy (PharmD) degree; 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, including synthesizing medical records, medication histories, payer criteria, and clinical evidence; Strong systems thinking to recognize recurring patterns, identify root causes, and improve review processes; Precise written communication and attention to detail, with the ability to provide structured feedback; High ownership and strong execution, working independently and reliably delivering accurate work at high volume; Excitement about working with and applying AI to clinical work, with intellectual curiosity, willingness to experiment, and judgement to challenge AI outputs and revise conclusions