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Utilisation Management / Case Management leader (RN/Physician-advisor)
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About the Role
Mercor is working with a leading AI research lab to improve the capabilities of next-generation AI systems. We are seeking experienced Utilisation Management and Case Management leaders - including RN UM directors, case management managers, and physician advisors - to evaluate AI tools designed to enhance clinical review, medical-necessity determination, and care-coordination workflows. Your clinical and operational expertise will directly shape AI systems that improve utilisation performance, reduce unnecessary care, and support value-based ca
What You'll Do
- Lead utilisation management and/or 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.
You're a Good Fit If You
- Relevant professional experience in this field.
- Strong written communication skills.
- Available for the stated weekly commitment.
Role Highlights
Pay & Payout
Independent contractor engagement, fully remote. Mercor pays weekly via Stripe or Wise.
Common Questions
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