Case Management Expert - Fully Remote | Upto $150/hr
关于工作的职位，默科尔将精英创意和技术人才与领先的人工智能研究实验室联系起来。总部位于旧金山，我们的投资者包括 Benchmark,General Catalyst,Peter Thiel,Adam D'Angelo,Larry Summers 和 Jack Dorsey.职位：利用管理/案例管理领导 （RN/医生顾问）类型：合同赔偿：$100~$150/小时位置：远程角色责任 ·领导使用管理和案件管理操作，包括同时审查，后期审查，放弃计划和护理协调。· 评估人工智能生成的医疗必要性确定，临床审查结果和 UM 决策支持建议以确保准确度和临床合适性。· 对 InterQual,MCG 或 Milliman 护理指南进行临床审查并监督，以支持接入，持续停留和护理水平的决定。·管理医生顾问计划来支持复杂的 UM 病例，同行审查请求和拒绝呼吁。·与临床团队，付费者和急症后提供商协调，以促进适当的护理转型和放弃规划。· 注册 AI 产品并提供结构化临床反，以支持培训数据集。资格 AI 必须有5年以上经验，在利用管理，案例管理或临床审查方面至少担任2年领导职位。· 有活跃的临床许可证 （RN 要求；医生顾问/MD 优先）和强大的医学需求审查专业知识。· 深入了解 InterQual,MCG 或 Milliman 临床评估标准。· CMS 两午夜规则，观察状态规定和住院标准方面的专业知识· ·与付款人一起管理医生顾客计划和同行评审过程的经验。·卓越的书面和口头沟通技巧。·高度关注细节，能够批判性评估临床文档和人工智能生成的 UM 输出。优先 • CPUR （使用审查中认证专业）,ACM （认证案例经理）或 CCM （认證案例经管）凭证 · MD 或 DO 与 UM/医生顾问经验优先用于医疗顾问角色。· UM 软件平台 （Allscripts,Utilisation Management 软件或相等）. ·熟悉 AI 工具以及评估人工智能产生临床审核内容的舒适度。· 在卫生系统，ACO 或基于价值的 UM 护理组织计划中的背景。应用程序流程
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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, 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.
Application Process (Takes 20–30 mins to complete)
- Upload resume
- AI interview based on your resume
- Submit form
Resources & Support
- For details about the interview process and platform information, please check:
- For any help or support, reach out to:
PS: Our team reviews applications daily. Please complete your AI interview and application steps to be considered for this opportunity.
Originally posted on Himalayas