Mentis AI · 1 month ago
Utilization Manager / Reviewer - Nurse (Health Insurance) required for AI Project (USA)
United States
Contract
Remote
Mid LevelMentis is seeking experienced utilization reviewers and managers with a nursing background to help develop and evaluate cutting-edge AI models for healthcare documentation and decision support. The role involves reviewing de-identified medical charts and assessing clinical appropriateness using established guidelines.
Computer Software
Responsibilities
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
Qualification
Required
Licensed RN, Utilization Review Specialist with experience in health insurance and payor‑side utilization management
Proficient in MCG and InterQual medical necessity criteria. Experience applying these in health plan or UM settings is essential
Professional English fluency for written deliverables
Comfortable working digitally with PDF/eFax records and structured annotation tools (training provided)
Right to work in your country of residence
Benefits
Flexible Work: Remote and asynchronous work.
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.
Company
Mentis AI
MentisPro is an end-to-end AI hiring platform that sources, vets and manages talent across the globe
2-10 employees
Funding
Current Stage
Early StageCompany data provided by crunchbase