Utilization Management Nurses

Role Overview

We’re seeking experienced Utility Management Nurses to support a client’s healthcare product development by leveraging expertise in insurance coding and hospital revenue management workflows. This role involves collaborating with hospital systems to align medical documentation with insurance policies, ensuring accurate coding and optimal reimbursement outcomes.

Key Responsibilities

• Insurance Coding & Revenue Cycle Alignment: Review, audit, and optimize insurance coding practices across hospital systems to ensure compliance and maximize reimbursement accuracy.

• Workflow Analysis: Evaluate existing revenue management workflows and recommend improvements tailored to client’s AI-driven documentation tools.

• Clinical Data Interpretation: Translate complex clinical notes into standardized coding formats (ICD-10, CPT, HCPCS) aligned with payer policies.

• Policy Matching: Assess coding accuracy against insurance guidelines and payer documentation requirements.

• Product Development Collaboration: Work closely with client’s engineering and product teams to refine AI models that automate or assist with medical coding and documentation.

• Compliance & Quality Assurance: Ensure alignment with HIPAA, CMS, and payer-specific coding regulations.

Required Qualifications

• Licensure: Registered Nurse (RN)

• Experience: Minimum 3–5 years in medical coding, clinical documentation improvement (CDI), or revenue cycle management.

• Certifications: CPC, CCS, or CRC certification preferred.

• Domain Expertise: Familiarity with hospital billing systems, payer policy interpretation, and coding audit procedures.

• Analytical Skills: Strong understanding of clinical documentation standards and payer logic.

• Tech Savvy: Comfortable working with EHR systems (Epic, Cerner, Meditech) and documentation review software.

Preferred Qualifications

• Experience working within hospital revenue integrity teams or insurance utilization management.

• Exposure to AI-powered healthcare documentation tools or automated coding systems.

• Ability to identify and flag edge cases or policy exceptions in automated workflows.

• Strong collaboration skills with cross-functional (engineering, compliance, and data) teams.

We consider all qualified applicants without regard to legally protected characteristics and provide reasonable accommodations upon request.

Contract and Payment Terms

• You will be engaged as an independent contractor.
• This is a fully remote role that can be completed on your own schedule.
• Projects can be extended, shortened, or concluded early depending on needs and performance.
• Your work at Mercor will not involve access to confidential or proprietary information from any employer, client, or institution.
• Payments are weekly on Stripe or Wise based on services rendered.
• Please note: We are unable to support H1-B or STEM OPT candidates at this time.

About Mercor

Mercor partners with leading AI labs and enterprises to train frontier models using human expertise. You will work on projects that focus on training and enhancing AI systems. You will be paid competitively, collaborate with leading researchers, and help shape the next generation of AI systems in your area of expertise.