What are the responsibilities and job description for the Utilization Review Nurse position at CASE HEALTH AI (CHAI)?
Company: Case Health AI
Location: Remote (Bonus if in Florida)
Type: Contract or part-time with Full-Time opportunity
Rate: $30–$50/hour (higher pay available depending on past experience)
Commitment: min 10 hours per week
Company Description
Case Health AI builds AI agents that automate health plan operations, starting with prior authorization. Our platform automates prior authorizations from intake, medical necessity review, to decision making. It works by finding the right clinical guidelines and then compares it to the medical documentation associated with the prior authorization.
We are looking for an experienced Utilization Management Nurse with strong health plan prior authorization experience to help ensure our AI agents are clinically accurate, using the correct guidelines, and making the correct decisions. 80% of your job will be double checking to make sure our AI is working properly.
Important
This role does not involve using InterQual or MCG directly. Instead, you will help the team work with payer-provided guidelines, CMS NCD/LCD policies, CMS manuals, NCCN guidelines, internal plan criteria, and other approved sources. Experienced in finding the appropriate guidelines and interpreting it without Interqual/mcg is important.
Role Description
This is a contract, remote role for a Utilization Review Nurse. The Utilization Review Nurse will assess and evaluate patient medical records within the context of utilization management guidelines. Responsibilities include ensuring appropriate care delivery, performing discharge planning, and reviewing medical documentation for adherence to clinical standards.
Qualifications
- Experience in Utilization Management for prior authorizations
- Experience working at a medicare health plan (medicaid bonus)
- Proficiency in reviewing, analyzing, and comparing Medical Records to guidelines
- Strong understanding of healthcare compliance and clinical guidelines
- Excellent critical thinking and decision-making skills
- Ability to work independently in a remote environment
- Fast communication skills
Salary : $30 - $50