Case Management Leader - Fully Remote | Upto $150/hr

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 Details

• Position: Utilisation Management / Case Management leader (RN/Physician-advisor)
• Type: Contract
• Compensation: $100–$150/hour
• Location: Remote

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 AI outputs and provide structured clinical feedback to support AI training datasets .

Qualifications

• 5+ years of experience 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 ) with strong medical necessity review expertise.
• Deep knowledge of InterQual , MCG , or Milliman clinical review criteria.
• Expertise in CMS Two-Midnight Rule , observation status regulations, and inpatient criteria.
• Experience managing physician advisor programs and peer-to-peer review processes with payers.
• Exceptional written and verbal English communication skills.
• High attention to detail with the ability to critically evaluate clinical documentation and AI-generated UM outputs .

Preferred

• CPUR , ACM , or CCM credential.
• MD or DO with UM/physician advisor experience preferred for physician advisor roles.
• Experience with UM software platforms (Allscripts , Utilisation Management software, or equivalent).
• Familiarity with AI tools and comfort evaluating AI-generated clinical review content.
• Background in health system, ACO, or value-based care organisation UM programs.