Founding Clinical Reviewer

Artificer Health - Remote (US hours overlap required)

Why this role exists

Prior authorization is not a neutral process. It was designed with friction built in. The documentation requirements, the payer-specific criteria that shift without notice, the peer-to-peer calls that get scheduled three weeks out - none of that is accidental. It is how health plans manage utilization, and the burden lands almost entirely on the people trying to get patients care.

You already know this. You have probably been on both sides of the wall. You know what a UnitedHealthcare clinical reviewer actually looks for when they open a musculoskeletal auth request. You know which language gets a Cigna appeal approved and which gets it upheld. You know that the difference between an approval and a denial is often not the clinical picture - it is one missing sentence in the physician's notes.

That knowledge lives in your head. Right now, it probably serves a spreadsheet, a review queue, or a denial management workflow that helps one organization at a time. We want to change what that expertise can do.

At Artificer Health, the Founding Clinical Reviewer is not a checkpoint. You are the clinical brain of the operation. You will define what good looks like - and then help us build a system that scales that standard across every submission we touch. Your knowledge teaches the automation. Your instincts set the floor. When a practice in Ohio gets a procedure approved that would have been denied a year ago, that is your work, even if your name is nowhere on the EOB.

We are pre-revenue, staying deliberately lean, and building toward a first integration with athenahealth. We are recruiting pilot customers now - small and mid-size medical practices that are bleeding time on prior auth and do not have the staff to absorb it. This role exists because we cannot build something that actually works without someone who has done the hard clinical work themselves.

What you'll actually do

Review submissions before they go to payers. You are the last set of clinical eyes on a prior authorization request before it leaves the platform. You check for clinical accuracy, documentation completeness, and likelihood of approval against the specific criteria of the specific payer receiving it. You flag what is missing, recommend what needs strengthening, and mark the cases that need a peer-to-peer before they go out rather than after they get denied.

Know the payer playbook. UnitedHealthcare is not Aetna is not Cigna is not Humana. You know what each plan is actually looking for behind the official criteria language. You track when those criteria change. You build and maintain internal payer profiles that make everyone on the team faster and smarter.

Help providers fix weak submissions in real time. You work directly with practice staff to close documentation gaps before submission. That means plain explanations, specific guidance, and zero condescension. The front desk coordinator who handles authorizations at a four-physician orthopedic practice is good at her job. Treat her that way.

Feed your expertise into the product. This is where the role gets unusual. Everything you learn - which payer criteria are shifting, which documentation gaps keep recurring, which clinical rationale language actually moves the needle - goes directly into how we build the automation. You are not advising from the outside. You are shaping the system from the inside.

Own the appeals layer. When submissions get denied, you lead the clinical appeal strategy. You know what wins and why. You write or guide the clinical appeal language. You identify which denials are worth fighting and which need a different approach. You do not hand this off.

Track patterns and report them. You are watching the data that matters: denial rates by payer, by procedure code, by specialty, by documentation gap type. You bring that back to the product team on a cadence that keeps us ahead of what payers are doing, not reacting to it.

What you bring

• Clinical background with direct experience in prior authorization, utilization review, or utilization management - as RN, LPN, clinical pharmacist, or experienced PA specialist with equivalent depth.
• Real familiarity with InterQual, MCG, or comparable clinical criteria sets - not awareness, fluency.
• Payer-side experience, whether as a UM reviewer, clinical reviewer, or appeal handler at a health plan or managed care organization - you understand how decisions get made from that side of the table.
• Command of CPT and ICD coding as it relates to medical necessity documentation - you know which codes trigger automatic clinical review and why.
• Experience with the appeal process at a level that goes beyond escalation - you have written clinical appeal letters, participated in peer-to-peer reviews, and tracked what actually changes outcomes.
• The ability to translate clinical reasoning into plain language that a practice manager, a billing coordinator, or a product engineer can act on.
• A bias toward moving rather than deliberating - you make a call, you own the call, you adjust if it was wrong.
• Willingness to work in an environment where the job description will change because the company is changing, and that does not unsettle you.

What we bring

Your expertise shapes the product directly. What you know does not disappear into a review queue. It becomes logic, criteria, documentation templates, payer profiles, and eventually automation that helps practices you will never speak to directly. The leverage is real.

No bureaucracy between you and the work. There is no approval chain for clinical recommendations. No committee. If you see something that needs to change, you say it and it changes or we have a conversation about why it should not.

A team that moves. We are small by design. That means you will work alongside people who are building the product, talking to customers, and making decisions in the same room - or the same Slack thread. You will not spend your days managing up.

Competitive compensation. Salary, equity, and benefits commensurate with a founding-level role at an early-stage startup. We will discuss specifics in the first conversation. We do not make people guess.

Remote, with real flexibility. We need overlap with US business hours. Everything else is yours to manage.

How to apply

Send an email to [email protected] with the subject line: Founding Clinical Reviewer.

Tell us where your experience with prior authorization actually came from - not your titles, the work. If you have been on the payer side, tell us what you saw. If you have a story about an appeal that should have been approved and was not, or one that should not have been approved and was, we want to hear it.

No cover letter template. No resume-padding. Just tell us who you are and why this is the right problem for you to work on.