Remote Utilisation & Case Management Leader (RN/MD)

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

Job summary

Mercor is seeking a Utilisation Management / Case Management leader (RN/Physician-advisor) to join their team remotely. This position involves leading operations and evaluating AI-generated clinical review outputs to ensure accuracy and appropriateness.

The ideal candidate will have over 5 years of experience in utilisation management with a strong focus on clinical criteria like InterQual, MCG, or Milliman. This role offers a competitive hourly compensation of $100–$150 based on experience.

Qualifications

• 5+ years in utilisation management or clinical review with leadership experience.
• Active RN license; MD preferred for physician advisor roles.
• Knowledge of InterQual, MCG, Milliman criteria is essential.

Responsibilities

• Lead utilisation and case management operations.
• Evaluate AI-generated medical necessity determinations.
• Conduct clinical reviews using InterQual, MCG, or Milliman guidelines.

Skills

Utilisation management

Clinical review

Leadership

Communication skills

Attention to detail

Education

Active RN license

MD/DO preferred

Tools

InterQual

MCG

Milliman

Job description

Mercor is seeking a Utilisation Management / Case Management leader (RN/Physician-advisor) to join their team remotely. This position involves leading operations and evaluating AI-generated clinical review outputs to ensure accuracy and appropriateness.

The ideal candidate will have over 5 years of experience in utilisation management with a strong focus on clinical criteria like InterQual, MCG, or Milliman. This role offers a competitive hourly compensation of $100–$150 based on experience.