Utilisation Management / Case Management leader (RN/Physician-advisor)

$100–150/hrrate as listed

Mercor is recruiting UM and case management leaders — RN directors, CM managers, and physician advisors — to review AI-generated medical necessity determinations and care-coordination outputs for a frontier AI lab. Work is remote and largely asynchronous, with observed rates of $100–150/hr depending on licensure and depth of review experience.

Summary, eligibility guidance and screening preparation are prepared by Sidequest from the platform's posting. Check the source listing before applying.

What the work involves

You will read AI-generated clinical review outputs and judge them the way you would judge a first-level reviewer's work. That means checking whether an admission recommendation actually maps to InterQual or MCG criteria, whether a continued-stay rationale is supported by the documentation provided, whether observation versus inpatient status holds up under the Two-Midnight Rule, and whether a discharge plan reflects realistic post-acute options. Tasks typically arrive as a case packet plus a model output; you rate it, flag the specific clinical or regulatory error, and write a short structured rationale a non-clinician trainer can follow. Some projects ask you to write reference determinations from scratch, or to compare two model responses and defend your preference.

What the platform screens for

Verifiable credentials. Active unrestricted RN license, or MD/DO for physician-advisor tracks. CPUR, ACM, or CCM helps.
Criteria fluency under follow-up. Expect to be pressed on how you apply a specific InterQual subset or MCG guideline, not just whether you have used them.
Regulatory precision. Two-Midnight Rule, CMS Conditions of Participation, condition code 44, payer-specific UM timelines.
Written clarity. Your feedback is training data. Vague criticism ("this doesn't seem right") has no value; specific criticism ("cites the wrong severity of illness criterion; documentation supports observation only") does.
Calibration. Reviewers who mark everything wrong, or everything acceptable, get filtered out quickly.

Logistics

Fully remote and asynchronous. Most contributors take 10–20 hours per week, with some projects offering more during ramp periods. Work is hourly contract through Mercor, invoiced against logged and reviewed task time. Onboarding usually includes a calibration set scored against expert consensus before paid work begins; rate placement within the $100–150 band tends to track licensure type, certification, and calibration performance. Nothing here is guaranteed — project volume shifts with the lab's research priorities.

What they look for

Active RN license (MD/DO for physician-advisor track) with medical necessity review experience
5+ years in utilisation management, case management, or clinical review, including 2+ in leadership
Working fluency with InterQual, MCG, or Milliman care guidelines
Command of CMS Two-Midnight Rule, observation status rules, and Conditions of Participation
Precise written English for structured clinical feedback and rationales
CPUR, ACM, or CCM certification (preferred)

Before you apply

Would you pass this screen?

Drawn from what this listing actually requires. Answered in your browser — nothing is sent to us, and we do not store your answers.

Do you hold an active, unrestricted Registered Nurse (RN) licence in the United States or Canada?
Active RN licence · required
Do you have 5 or more years of professional experience in utilisation management, case management, or clinical review roles?
5+ years UM/case management experience · required
Do you have at least 2 years of experience in a formal leadership role managing utilisation management or case management operations or staff?
2+ years leadership experience in UM/CM · required
Do you have hands-on experience applying InterQual, MCG, or Milliman clinical review criteria in operational medical necessity determinations?
Deep knowledge of one major criteria set · required
Do you hold a current CPUR (Certified Professional in Utilisation Review), ACM (Accredited Case Manager), or CCM (Certified Case Manager) certification?
CPUR, ACM, or CCM credential · preferred
Are you a physician (MD, DO, or equivalent international credential) with experience in utilisation management or physician-advisor roles?
Physician (MD/DO) status · preferred

0 of 6 answered

Included with this listing

Interview prep — 11 questions

Matched to what this platform's screening actually measures. Answer each out loud in 60–90 seconds: claim → concrete example → implication.

What it tests: Whether the candidate has genuine hands-on experience managing physician-advisor-led advocacy, not just administrative oversight. Can they articulate the clinical reasoning that persuades a payer medical director to reverse a denial.
A strong answer: The answer names a specific clinical scenario (e.g. prolonged ICU stay, observation vs. inpatient boundary case), explains the payer's initial position and the clinical evidence the candidate or their physician advisor marshalled to challenge it, and describes the outcome—showing they understand both sides of the medical-necessity argument.
Where people lose it: Describing denial management only at the operational or metrics level ('we reduced denials by 15%') without recounting a single clinical argument. This signals the candidate oversees the process but may not deeply understand the medical reasoning that wins peer-to-peer reviews.