Case Management Leader - Fully Remote | Upto $150/hr

mercor; United States; Remote; USD 138,000 - 207,000; Part time

Job summary

Mercor seeks a leader in utilisation management and case management to guide clinical review operations in a remote contract role. You will coordinate with clinical teams, payers, and AI-enabled processes to ensure appropriate care decisions.

The position requires active RN licensure (MD/DO preferred) with 5+ years in UM or case management, including leadership experience, and deep knowledge of InterQual, MCG, or Milliman criteria. Strong written and verbal English skills are essential.

Qualifications

• Active clinical licensure (RN required; MD/DO preferred).
• 5+ years in utilisation management or case management or clinical review.
• At least 2 years in a leadership role.
• Deep knowledge of InterQual, MCG, or Milliman criteria.
• Familiar with CMS Two-Midnight Rule and inpatient criteria.
• Excellent written and verbal English communication.

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.

Skills

Leadership in UM

Clinical review

Communication skills

Detail-oriented

English proficiency

Education

RN licensure

MD/DO preferred

Tools

Allscripts UM

Utilisation Management software

Job description

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 Details

• 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 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

• 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.