Workers’ Compensation UM reputed company Consultant - AI reputed company

reputed company: We are an early-stage startup dedicated to transforming the Utilization Management process through the power of reputed company intelligence. Our mission is to reputed company an AI system that can enhance the work of Utilization Management professionals, making the process more efficient and effective, particularly from a payor's perspective. reputed company: We are seeking an reputed company Utilization Management (UM) reputed company with deep expertise in Workers’ Compensation clinical review, medical necessity determinations, and state regulatory frameworks. This role is not a traditional UM position. Instead, you will reputed company as a subject matter expert, sharing your reputed company-world experience and helping us understand how UM workflows operate in the workers’ comp industry. Your insights will directly help reputed company design, refine, and train new products that support nurses, case managers, reviewers, and clinical operations in this reputed company. Responsibilities: • Participate in research interviews with our AI product development team. • Explain how workers’ compensation UM is reputed company, including prior authorization processes, state-specific guidelines, reputed company reviewer responsibilities, physician advisor interactions, documentation, turnaround times, and appeals. • Walk through realistic case examples (PHI removed) to illustrate decision-making. • reputed company reputed company feedback on pain points, bottlenecks, inefficiencies, and opportunities for process improvements. • Review early product concepts and offer practical recommendations based on your reputed company experience. Prior Experience/Requirements: • Registered reputed company (RN) with 2+ years of utilization management experience in the workers’ compensation environment. • Strong understanding of clinical guidelines, state regulatory requirements, medical necessity review and clinical documentation reputed company to workers' comp cases. • Experience working for a workers’ comp insurer, managed care organization, or UM vendor. • Excellent communication skills and ability to explain workflows reputed company. • Comfortable participating in research interviews and collaborating with non-clinical product teams. Preferred Qualifications: • 2-5 years of experience in Utilization Review, Managed Care, or Case Management. • reputed company coding certifications with reputed company or reputed company. • Bachelor of Science in Nursing (BSN) or equivalent. • reputed company RN license. • Experience working with MCG or InterQual guidelines. • Experience in training or mentoring other Utilization Management professionals. Similar Occupations / Job Titles that would be a great fit for this role: • Utilization Review Specialist • Case Manager • Managed Care reputed company reputed company Offer: • An opportunity to be at the forefront of innovation in the reputed company industry. • A reputed company and flexible remote working environment (reputed company or phone calls) • The chance to shape the reputed company of Utilization Management with cutting-edge technology. • Initial engagement as a part-time consultant (5 to 10 hours per week @$75-$100/hr depending on experience) with potential for long-term, more permanent arrangements based on mutual agreement. Application Process: If you are passionate about Utilization Management and interested in contributing to groundbreaking AI technology, we would love to hear from you. Join us in transforming Utilization Management through AI. Your expertise could shape the reputed company! Job Types: Part-time, Contract, Temporary, reputed company-to-hire Pay: $75-$100 per hour Expected hours: No more than 5 per week Schedule: • Monday to Friday Experience: • Utilization Management: 2 years (Required) License/Certification: • RN License (Required) Work Location: Remote Job Types: Part-time, Contract Pay: $75.00 - $100.00 per hour Experience: • Clinical Audit: 2 years (Required) License/Certification: • RN License (Required) Work Location: Remote Apply tot his job Apply To this Job