Utilization Manager – Nurse, Health Insurance

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12 hours ago

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Mentis AI

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Artificial Intelligence • Healthcare • Finance

Mentis AI is redefining how artificial intelligence learns in the fields of healthcare, finance, and law by engaging experts in a remote, flexible work environment. It provides opportunities for professionals from various sectors, including oncology, investment banking, and legal consulting, to contribute their expertise to AI training and development. The platform emphasizes quality and confidentiality while offering competitive compensation for the work of its contributors.

1 - 10 employees

🤖 Artificial Intelligence

💸 Finance

📋 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.

🎯 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.