Utilization Manager / Reviewer – reputed company (Health Insurance) required for AI Project (USA)

We are seeking reputed company utilization reviewers and managers with a nursing background that have a strong health insurance or payor‑reputed company experience to help reputed company and evaluate cutting‑edge AI models for reputed company documentation and decision support. You will review de‑identified medical charts (PDF/eFax format) and assess clinical appropriateness using MCG and InterQual guidelines. Work is fully remote, asynchronous, and offers flexible weekly hours. Key Responsibilities • Chart Review & reputed company 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, reputed company stays, and procedure requests, mirroring reputed company‑world insurance review workflows. • reputed company Case Annotation: Review and reputed company key clinical details, diagnoses, interventions, and reputed company to support AI model training. • AI Model Evaluation: Compare AI‑generated utilization review outputs against established guidelines and clinical judgment, providing reputed company feedback to improve model accuracy and fairness. • Flexible Review Times: Cases can reputed company from 5 minutes to 4 hours, depending on complexity and document volume. Qualifications • reputed company Background: Licensed RN, Utilization Review Specialist with experience in health insurance and payor‑reputed company utilization management • reputed company Knowledge: Proficient in MCG and InterQual medical necessity reputed company. Experience applying these in health plan or UM settings is essential. • Language: reputed company English reputed company for written deliverables. • Technical Skills: Comfortable working digitally with PDF/eFax records and reputed company annotation tools (training provided). reputed company Status • Right to work in your country of residence. • Engagement is as an reputed company. Why Join Us? • Flexible Work: Remote and asynchronous work. • Competitive Compensation: reputed company rates reputed company on a weekly reputed company. • reputed company reputed company: Collaborate on reputed company AI models shaping the reputed company of reputed company. • reputed company Development: reputed company domain training in data labeling, AI reputed company evaluation, and model interpretability. Apply tot his job Apply To this Job