Case Management Expert — Utilization Management, Remote

Job overview

The Case Management Expert — Utilization Management role is remote. The posting states compensation of $100–$150 per hour and identifies the position as contract work. Mercor connects creative and technical talent with AI research labs. The role provides clinical leadership and review for utilization and case management operations, including evaluating AI-generated medical necessity and clinical review outputs. It also supports care coordination, physician-advisor processes, and structured feedback used to improve AI training datasets.

What you'll do

• Lead utilization and case management operations, including concurrent and retrospective review, discharge planning, and care coordination
• evaluate AI-generated medical necessity determinations and review outputs
• conduct reviews against InterQual, MCG, or Milliman guidelines
• manage physician-advisor support for complex cases, peer-to-peer reviews, and appeals
• coordinate care transitions
• annotate AI outputs and provide structured clinical feedback.

What we're looking for

Skills & competencies

case management expert

utilization management

remote

mercor

clinical review

registered nurse

medical necessity

discharge planning

care coordination

ai evaluation

interqual

$100–$150/hr

Work arrangement

• Weekend coverage required

Why this role

Requires active clinical licensure, with RN required and physician advisor/MD preferred; the posting seeks 5+ years of relevant experience, including 2+ years in leadership.

About the employer

Mercor is hiring for this role. Industry: All Other Professional, Scientific, and Technical Services. Sector: 54.