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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 ... Show more
Private Client Advisor Associate.The main purpose of this job is to support the Private Client Advisors who are accountable for the delivery of wealth management advisory services to high net worth... Show more
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
We offer options for every body: sunbed tanning, spray tanning, skin care, and wellness.We're looking for passionate, hard-working individuals to represent our brand.If you're a fun-seeking, team p... Show more
Financial Advisor Opportunity At Northwestern Mutual.Becoming a financial advisor at Northwestern Mutual is a unique opportunity to start a business where you can help your clients achieve their go... Show more
Overview** We are hiring a **Consultant / Advisor** who provides advisory, strategic, or consulting services across industries.In this role, you will review, assess, and provide structured feedback... Show more
Supervisory Acquisition Utilization Specialist.The Supervisory Acquisition Utilization Specialist renders expert contract pre-award and post award expertise to all Administrative and Clinical Servi... Show more
Registered Nurse (RN) | Interventional Radiology.INTERVENTIONAL RADIOLOGY - RN Available!.With Envista Healthcare Staffing, your healthcare career is an open ticket to wherever your dreams lead—.Wh... Show more
We are looking for enthusiastic and service-driven individuals to join our team as Remote Travel Advisors.In this role, you will help clients plan and book memorable travel experiences, including c... Show more
By working at Sally Beauty, you would be part of the largest hair and beauty supplier in the world and we are on a mission to empower our customers to express themselves through hair and we need p... Show more
We're looking for organized, dependable professionals who enjoy creating well-managed experiences for clients and keeping important details on track.You will support the client journey from initial... Show more
Certified Registered Nurse Anesthetist | Anesthesiology - General/Other.Competitive weekly pay (inquire for details).LocumJobsOnline is working with LocumTenens.Anesthesiology CRNA in Missouri!.Job... Show more
KVC Missouri Transitional Living Group Home.Location: Columbia, MO Pay: $18.Youth Advisors play a crucial role in cultivating a secure treatment environment and promoting positive youth development... Show more
We're looking for candidates with great customer service skills to fill our Remote Customer Service role!.This role is entirely remote and offers full-time/Part time hours with flexibility.We are r... Show more
We're Hiring a Insurance Sales Producer (Commercial)!Join Our 100% Employee-Owned TeamAt Winter-Dent, our mission is to help individuals and businesses protect what matters most-whether it's their ... Show more
Join the Leader in the Industry!.If you’re a fun-seeking, team player who thrives.Why You’ll Love Working With Us:.Competitive Pay – Base pay + commission opportunities!.Welcoming Atmosphere – Work... Show more
WealthBridge Financial Group is seeking a results-oriented .In this position, you will engage with clients to understand their financial objectives and provide them with tailored advice and st... Show more
This full-time position offers flexible work hours and ample opportunities for advancement into management roles.You will work remotely to serve clients and offer valuable advice and protection to ... Show more
Excellent Training – with opportunities for training and career advancement.Medical, dental, vision, available after 60 days.Are you ready to join the winning team? At Lee's Tire, our team has a co... Show more
Join our winning sales team to experience Sony, where today's innovation is transforming tomorrow's entertainment!.ActionLink is seeking a driven.Demonstrate the latest innovations in Sony home cin... Show more
The average salary range is between $ 31,200 and $ 46,803 year , with the average salary hovering around $ 35,975 year .
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.
