Remote Utilization & Case Management Lead (RN/MD)

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

Job summary

Mercor connects elite creative and technical talent with leading AI research labs. A remote Utilisation Management leader role is available, requiring RN licensure and physician-advisor experience.

Contract position with high-level responsibility and collaboration across payers and clinical teams. The role emphasizes overseeing concurrent and retrospective reviews, discharge planning, and AI-enabled decision-support validation, with strong English communication skills and meticulous attention to

Qualifications

• 5+ years 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).
• Deep knowledge of InterQual, MCG, or Milliman clinical review criteria.
• Expertise in CMS Two-Midnight Rule, observation status regulations, and inpatient criteria.

Responsibilities

• Lead utilisation management and case management operations, including concurrent and retrospective reviews, discharge planning, and care coordination.
• Evaluate AI-generated medical necessity determinations and UM decision-support outputs for accuracy and appropriateness.
• Conduct and oversee clinical reviews against InterQual, MCG, or Milliman guidelines to support admission and level-of-care determinations.
• Manage the physician advisor program to support complex UM cases, peer-to-peer reviews, and denial appeals.
• Coordinate with clinical teams, payers, and post-acute providers to facilitate care transitions and discharge planning.
• Annotate AI outputs and provide structured clinical feedback to support AI training datasets.

Skills

Leadership

Clinical review

English communication

AI evaluation

Attention to detail

Education

Registered Nurse (RN) licensure

Tools

Allscripts

Utilisation Management software

Job description

Mercor connects elite creative and technical talent with leading AI research labs. A remote Utilisation Management leader role is available, requiring RN licensure and physician-advisor experience.

Contract position with high-level responsibility and collaboration across payers and clinical teams. The role emphasizes overseeing concurrent and retrospective reviews, discharge planning, and AI-enabled decision-support validation, with strong English communication skills and meticulous attention to