Talent.com
Mercor
Remote Utilisation Management / Case Management leader (RN/Physician-advisor) - AI TrainerMercor • Green Bay, Wisconsin, US
Remote Utilisation Management / Case Management leader (RN/Physician-advisor) - AI Trainer

Remote Utilisation Management / Case Management leader (RN/Physician-advisor) - AI Trainer

Mercor • Green Bay, Wisconsin, US
30+ days ago
Job type
  • Full-time
  • Remote
Job description
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 care objectives. **Responsibilities** - 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. - Coordinate with clinical teams, payers, and post-acute providers to facilitate appropriate care transitions and discharge planning. - Monitor UM/CM KPIs, including avoidable days, denial rates, observation vs. inpatient conversion rates, and readmission rates. - Ensure compliance with CMS Conditions of Participation, Two-Midnight Rule, and payer-specific UM requirements. - Collaborate with revenue cycle, compliance, and clinical leadership to align UM performance with financial and quality objectives. - Annotate AI outputs and provide structured clinical feedback to support AI training datasets. **Requirements** - 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 Qualifications** - CPUR (Certified Professional in Utilisation Review), ACM (Accredited Case Manager), or CCM (Certified Case Manager) 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. **Why Join?** - Contribute to the development of frontier AI systems in healthcare. - Collaborate with a world-class AI research organisation. - Gain exposure to cutting-edge AI workflows in utilisation management and clinical decision-support. - Opportunity to work on high-impact projects shaping the future of healthcare AI.
Create a job alert for this search

Remote Utilisation Management / Case Management leader (RN/Physician-advisor) - AI Trainer ($100-$150 per hour) • Green Bay, Wisconsin, US

Similar jobs

Remote Product Tester - Flexible Studies

BuzzTestersDe Pere, WI
Remote
Full-time

Earn up to $400/week, depending on the number and type of studies you complete.Share honest feedback on products and services from independent brands.Assignments include short online surveys (10–20... Show more

 • Promoted

Flexible Remote Work – Get Paid to Share Your Opinions on Top Brands

OCPAColeman, Wisconsin, us
$15.00 hourly
Remote
Part-time +1

Product Testers are wanted to work from home nationwide in the US to fulfill upcoming contracts with national and international companies.We guarantee 15-25 hours per week with an hourly pay of bet... Show more

 • Promoted

Direct Care Worker- Suring

UnitedHealthcareOconto, WI, United States
Full-time

Explore opportunities with Almost Family, a part of LHC Group, a leading post-acute care partner for hospitals, physicians and families nationwide.As members of the Optum family of businesses, we a... Show more

 • Promoted

Direct Care Worker- Oconto Falls 1061751 | Oconto Falls, Wisconsin | LHC Group

UMROconto Falls, WI, United States
Full-time

Explore opportunities with Almost Family, a part of LHC Group, a leading post-acute care partner for hospitals, physicians and families nationwide.As members of the Optum family of businesses, we a... Show more

 • Promoted

Physical Therapist Assistant (PTA) In House PRN

Evolve Therapy ServicesOconto, WI, United States
Full-time

Evolve Therapy Services is a therapy management organization hiring compassionate therapists for our partner located in Oconto, WI!.Job Position: Physical Therapy Assistant for an In-house Skilled ... Show more

 • Promoted

Direct Care Worker- Oconto 1061243 | Oconto, Wisconsin | LHC Group

United Health GroupOconto, WI, United States
Full-time

Home And Community Based Services Aide.Explore opportunities with Almost Family Personal Care, a part of LHC Group, a leading post-acute care partner for hospitals, physicians and families nationwi... Show more

 • Promoted

Travel Nurse - RN - Case Manager - $2080 / Week - Remote

Premier Medical Staffing Services, LLCGreen Bay, WI, United States
Remote
Full-time

Premier Medical Staffing Services, LLC is seeking an experienced Case Manager Registered Nurse for an exciting Travel Nursing job in Green Bay, WI.Shift:5x8 hr days Start Date:ASAP Duration:13 week... Show more

 • Promoted

Travel Nurse RN - ED - Emergency Department - $2,282 per week

TNAA TotalMed RNOconto, WI, United States
Permanent

TNAA TotalMed RN is seeking a travel nurse RN ED - Emergency Department for a travel nursing job in Oconto, Wisconsin.Job Description & Requirements Specialty:ED - Emergency Department Discipli... Show more

 • Promoted

Consumer Research Associate (Remote)

GL IncBellevue, Wisconsin
$15.00 hourly
Remote
Part-time +1

Product Testers are wanted to work from home nationwide in the US to fulfill upcoming contracts with national and international companies.We guarantee 15-25 hours per week with an hourly pay of bet... Show more

 • Promoted

County Meter Reader

Meter ReaderLena, WI
Full-time

Responsibilities The primary responsibility of this position is to read meters and record consumption of the water used, cleaning of meter boxes, and removal of vegetation impeding access to meters... Show more

 • Promoted

CMA/LPN- Family Medicine- Oconto Falls

Prevea HealthOconto Falls, WI, United States
Full-time

This position will work 32 hours per week CMA/LPN.Come work where we specialize in you! We have nearly 2,000 reasons for you to consider a career with Prevea Healththey're our employees.We're an or... Show more

 • Promoted

Direct Care Worker- Oconto Falls 1061751 | Oconto Falls, Wisconsin | LHC Group

Reliant Medical GroupOconto Falls, WI, United States
Full-time

Explore opportunities with Almost Family, a part of LHC Group, a leading post-acute care partner for hospitals, physicians and families nationwide.As members of the Optum family of businesses, we a... Show more

 • Promoted

Travel Nurse RN - Case Management - $2,046 per week

Skyline Med Staff NursingGreen Bay, WI, United States
Full-time

Skyline Med Staff Nursing is seeking a travel nurse RN Case Management for a travel nursing job in Green Bay, Wisconsin.Job Description & Requirements Specialty:Case Management Discipline:RN St... Show more

 • Promoted

Medical Courier

Blue Collar StaffingLena, WI
Full-time

We're looking for a reliable and professional Medical Courier to transport time-sensitive medical materials — including lab specimens, pharmaceuticals, medical equipment, and patient records — betw... Show more

 • Promoted

Mental Health Therapist - Remote

WellQorDe Pere, WI, United States
Remote
Part-time

Job DescriptionJob DescriptionAbout WellQor :WellQor is a patient centered, full-service psychological practice accessible online.We put our long-term personal relationships with clients at the hea... Show more

 • Promoted

Physical Therapy Assistant PTA

Oconto Health and Rehabilitation CenterOconto, WI, United States
Full-time +1

Physical Therapy Assistant (PTA).Oconto Health and Rehab is hiring compassionate Physical Therapy Assistant (PTA) to join our Therapy Team.As a PTA, you will work alongside our growing department o... Show more

 • Promoted

Direct Care Worker- Oconto Falls 1061751 | Oconto Falls, Wisconsin | LHC Group

divvyDOSEOconto Falls, WI, United States
Full-time

Explore opportunities with Almost Family, a part of LHC Group, a leading post-acute care partner for hospitals, physicians and families nationwide.As members of the Optum family of businesses, we a... Show more

 • Promoted

Work From Home

Remote JobsOconto, WI
Remote
Full-time

Remote Jobs are now available in your area.This position is a work from home position.You will not need to come into the office.Benefits: Health Insurance, 401K, Vacation& PTO.Apply now! Work f... Show more

 • Promoted

Work From Home

AmazonLena, WI
Remote
Full-time

Job Title: Work From Home Customer Service Representative.As a Work From Home Customer Service Representative at Amazon, you will be the first point of contact for customers seeking assistance.You ... Show more

 • Promoted

Direct Care Worker- Oconto 1061243 | Oconto, Wisconsin | LHC Group

Reliant Medical GroupOconto, WI, United States
Full-time

Home And Community Based Services Aide.Explore opportunities with Almost Family Personal Care, a part of LHC Group, a leading post-acute care partner for hospitals, physicians and families nationwi... Show more