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Utilization Manager – Nurse, Health Insurance

Artificial IntelligenceArtificial IntelligenceContractRemoteTeam 1-10H1B No SponsorCompany Site LinkedIn

Location

United States

Posted

102 days ago

Salary

Not specified

Professional CertificateEnglish

Job Description

• Chart Review & Guideline Assessment: Review de‑identified medical charts to determine medical necessity and level‑of‑care appropriateness based on MCG and InterQual guidelines. • Health Insurance Case Context: Apply your health plan knowledge to evaluate admissions, continued stays, and procedure requests, mirroring real‑world insurance review workflows. • Structured Case Annotation: Review and highlight key clinical details, diagnoses, interventions, and outcomes to support AI model training. • AI Model Evaluation: Compare AI‑generated utilization review outputs against established guidelines and clinical judgment, providing structured feedback to improve model accuracy and fairness. • Flexible Review Times: Cases can range from 5 minutes to 4 hours, depending on complexity and document volume.

Job Requirements

Professional Background: Licensed RN, Utilization Review Specialist with experience in health insurance and payor‑side utilization management
Guideline Knowledge: Proficient in MCG and InterQual medical necessity criteria. Experience applying these in health plan or UM settings is essential.
Language: Professional English fluency for written deliverables.
Technical Skills: Comfortable working digitally with PDF/eFax records and structured annotation tools (training provided).

Benefits

Flexible Work: Remote and asynchronous work.
Competitive Compensation: Hourly rates paid on a weekly basis.
Professional Insight: Collaborate on next‑generation AI models shaping the future of healthcare.
Skill Development: Gain domain training in data labeling, AI quality evaluation, and model interpretability.