Remote Utilisation & Case Management Leader

Mercor; San Francisco (CA); On-site; USD 137,760 - 206,640; Part time

Job summary

Mercor is seeking a Utilisation Management / Case Management leader (RN/Physician-advisor) based in San Francisco, California. This remote position involves leading operations in utilisation management, conducting clinical reviews, and evaluating AI-generated medical content.

The ideal candidate will have over 5 years of experience in relevant fields and strong communication skills. They must hold active RN licensure, with MD or DO preferred for physician advisor roles. A deep understanding of clinical review criteria is required.

Qualifications

• 5+ years of experience in utilisation management, case management, or clinical review.
• At least 2 years in a leadership role.
• Strong medical necessity review expertise.

Responsibilities

• Lead utilisation management and case management operations.
• Evaluate AI-generated medical necessity determinations.
• Conduct and oversee clinical reviews against care guidelines.

Skills

Utilisation Management

Case Management

Clinical Review

Leadership

Communication Skills

Attention to Detail

Education

Active RN licensure

MD or DO (preferred for physician advisor roles)

Tools

Utilisation Management software

Job description

Mercor is seeking a Utilisation Management / Case Management leader (RN/Physician-advisor) based in San Francisco, California. This remote position involves leading operations in utilisation management, conducting clinical reviews, and evaluating AI-generated medical content.

The ideal candidate will have over 5 years of experience in relevant fields and strong communication skills. They must hold active RN licensure, with MD or DO preferred for physician advisor roles. A deep understanding of clinical review criteria is required.