About the role
About the job
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: Utilisation Management / Case Management leader (RN/Physician-advisor) Type:Contract Compensation:$100–$150/hour Location:Remote
Role 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