CASE MANAGEMENT LEADER - FULLY REMOTE | UPTO $150/HR

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 Role Responsibilities • Lead utilisation management and case management operations, including concurrent review, retrospective review, discharge planning, and care coordination. • Evaluate AI-generated medical necessity determinations and clinical review outputs for accuracy and clinical appropriateness. • Conduct and oversee clinical reviews against InterQual , MCG , or Milliman care guidelines to support admission 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 , ACM , or CCM 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. Resources & Support • For details about the interview process and platform information, please check: https://talent.docs.mercor.com/welcome • For any help or support, reach out to: support@mercor.com PS: Our team reviews applications daily. Please complete your AI interview and application steps to be considered for this opportunity.