Utilisation Management / Case Management Leader (RN / Physician-Advisor)

Transforming Healthcare Delivery Through Advanced AI Systems

The intersection of clinical leadership and artificial intelligence is no longer a futuristic concept—it is actively unfolding right now. Across the healthcare landscape, organizations are striving to streamline complex administrative pathways, optimize patient outcomes, and eliminate redundant medical reviews. However, building intelligent systems capable of managing medical necessity and care coordination requires deep, nuanced domain expertise that only seasoned healthcare professionals can provide.

Mercor is currently partnering with a pioneering AI research lab dedicated to improving the capabilities of next-generation AI systems. This unique initiative seeks experienced Utilisation Management (UM) and Case Management leaders—including Registered Nurse UM directors, case management managers, and physician advisors—to evaluate and refine state-of-the-art AI tools. These tools are engineered to enhance clinical review accuracy, refine medical-necessity determinations, and optimize care-coordination workflows across modern healthcare networks.

If you are an accomplished clinical leader looking to step out of rigid hospital silos while commanding a competitive compensation package of $100 to $150 per hour on a flexible, remote contract, this is your definitive guide to securing this high-impact opportunity.

Role Overview & Key Responsibilities

As a Utilisation Management / Case Management Leader with Mercor, your operational and clinical insights will directly shape frontier AI algorithms. Your core responsibilities will bridge clinical excellence with technological innovation:

• Leadership & Operations: Lead utilization management and/or case management operations, encompassing concurrent reviews, retrospective reviews, structured discharge planning, and comprehensive care coordination.
• AI Evaluation & Annotation: Rigorously evaluate AI-generated medical-necessity determinations, clinical review outputs, and decision-support recommendations to ensure absolute accuracy and clinical appropriateness. Provide structured clinical feedback to support ongoing AI training datasets.
• Evidence-Based Criteria Review: Conduct and oversee complex clinical reviews utilizing established industry criteria including InterQual, MCG, or Milliman care guidelines to support patient admission, continued stay, and level-of-care determinations.
• Physician Advisor Oversight: Manage and guide physician advisor programs to effectively handle complex UM cases, formal peer-to-peer review requests, and structured denial appeals.
• KPI & Compliance Monitoring: Track critical UM/CM Key Performance Indicators, including avoidable days, denial rates, observation-versus-inpatient conversion rates, and readmission metrics, ensuring strict adherence to CMS Conditions of Participation, the Two-Midnight Rule, and payer-specific mandates.

Candidate Requirements & Preferred Qualifications

To succeed in this high-caliber position, candidates must meet rigorous professional standards demonstrating both clinical depth and administrative mastery:

• Experience: A minimum of 5 years of progressive experience in utilization management, case management, or clinical review, featuring at least 2 years in a dedicated leadership role.
• Licensure: Active clinical licensure (RN required; physician advisor/MD candidates strongly preferred) paired with deep expertise in medical-necessity reviews.
• Framework Knowledge: Comprehensive familiarity with InterQual, MCG, or Milliman clinical review guidelines, alongside expert comprehension of the CMS Two-Midnight Rule and observation status regulations.
• Communication: Exceptional written and verbal English communication skills, coupled with meticulous attention to detail when evaluating complex clinical documentation.
• Preferred Credentials: Holding a CPUR (Certified Professional in Utilisation Review), ACM (Accredited Case Manager), or CCM (Certified Case Manager) credential is a distinct advantage. Familiarity with UM software suites (such as Allscripts) and early comfort with AI-driven clinical tools will set top applicants apart.

Why Join This Initiative?

Stepping into the world of HealthTech AI consulting offers unmatched professional growth. Beyond the lucrative $100–$150/hr rate paid weekly through Stripe or Wise, this project allows you to leave a lasting footprint on how technology supports clinical decision-making. You will gain rare exposure to cutting-edge AI workflows, collaborate with elite researchers, and future-proof your career background by positioning yourself at the forefront of digital healthcare transformation.

Please note that positions on these frontier AI training tracks are highly competitive and are filled on a rolling basis. Candidates requiring H1-B or STEM OPT visa sponsorship are currently unable to be supported for this independent contractor engagement.