About the job Mercor connects elite creative and technical talent with leading AI research labs. Headquartered in San Francisco, our investors include Benchmark , General Catalyst , Peter Thiel , Adam D'Angelo , Larry Summers , and Jack Dorsey . Position: Utilisation Management / Case Management leader (RN/Physician-advisor) Type: Contract Compensation: $100–$150/hour Location: Remote Responsibilities Lead utilisation management and case management operations, including concurrent review, retrospective review, discharge planning, and care coordination. Evaluate AI-generated medical necessity determinations, clinical review outputs, and UM decision-support recommendations for accuracy and clinical appropriateness. Conduct and oversee clinical reviews against InterQual , MCG , or Milliman care guidelines to support admission, continued stay, and level-of-care determinations. Manage the physician advisor program to support complex UM cases, peer-to-peer review requests, and denial appeals. Coordinate with clinical teams, payers, and post-acute providers to facilitate appropriate care transitions and discharge planning. Annotate AI outputs and provide structured clinical feedback to support AI training datasets . Qualifications Must-Have 5+ years of experience in utilisation management , case management , or clinical review, with at least 2 years in a leadership role. Active clinical licensure ( RN required ; physician advisor/ MD preferred ) with strong medical necessity review expertise. Deep knowledge of InterQual , MCG , or Milliman clinical review criteria. Expertise in CMS Two-Midnight Rule , observation status regulations, and inpatient criteria. Experience managing physician advisor programs and peer-to-peer review processes with payers. Exceptional written and verbal English communication skills. High attention to detail with the ability to critically evaluate clinical documentation and AI-generated UM outputs . Preferred CPUR (Certified Professional in Utilisation Review), ACM (Accredited Case Manager), or CCM (Certified Case Manager) credential. MD or DO with UM/physician advisor experience preferred for physician advisor roles. Experience with UM software platforms ( Allscripts , Utilisation Management software , or equivalent). Familiarity with AI tools and comfort evaluating AI-generated clinical review content. Background in health system, ACO , or value-based care organisation UM programs. #J-18808-Ljbffr
Case Management Expert - Fully Remote | Upto $150/hr in workfromhome at Unknown Company
This position is listed as contract and able to be worked remotely.