Workers’ Compensation UM Nurse Consultant - AI Strategy
About Us: We are an early-stage startup dedicated to transforming the Utilization Management process through the power of artificial intelligence. Our mission is to develop an AI system that can enhance the work of Utilization Management professionals, making the process more efficient and effective, particularly from a payor's perspective. Role Overview: We are seeking an experienced Utilization Management (UM) Nurse with deep expertise in Workers’Compensation clinical review, medical necessity determinations, and state regulatory frameworks.This role is not a traditional UM position. Instead, you will act as a subject matter expert, sharing your real-world experience and helping us understand how UM workflows operate in the workers’ comp industry. Your insights will directly help our team design, refine, and train new products that support nurses, case managers, reviewers, and clinical operations in this space. Responsibilities:• Participate in research interviews with our AI product development team. • Explain how workers’ compensation UM is structured, including prior authorization processes, state-specific guidelines, nurse reviewer responsibilities, physician advisor interactions, documentation, turnaround times, and appeals.• Walk through realistic case examples (PHI removed) to illustrate decision-making. • Provide candid feedback on pain points, bottlenecks, inefficiencies, and opportunities for process improvements. • Review early product concepts and offer practical recommendations based on your frontline experience. Prior Experience/Requirements:• Registered Nurse (RN) with 2+ years of utilization management experience in the workers’ compensation environment. • Strong understanding of clinical guidelines, state regulatory requirements, medical necessity review and clinical documentation related to workers' comp cases.• Experience working for a workers’ comp insurer, managed care organization, or UM vendor. • Excellent communication skills and ability to explain workflows clearly. • Comfortable participating in research interviews and collaborating with non-clinical product teams. PreferredQualifications:• 2-5 years of experience in Utilization Review, Managed Care, or Case Management. • Current coding certifications with AAPC or AHIMA. • Bachelor of Science in Nursing (BSN) or equivalent. • Active RN license. • Experience working with MCG or InterQual guidelines.• Experience in training or mentoring other Utilization Management professionals. Similar Occupations / Job Titles that would be a great fit for this role:• Utilization Review Specialist• Case Manager• Managed Care NurseWhat We Offer:• An opportunity to be at the forefront of innovation in the healthcare industry. • A collaborative and flexible remote working environment (zoom or phone calls)• The chance to shape the future of Utilization Management with cutting-edge technology. • Initial engagement as a part-time consultant (5 to 10 hours per week @$75-$100/hr depending on experience) with potential for long-term, more permanent arrangements based on mutual agreement.Application Process: If you are passionate about Utilization Management and interested in contributing to groundbreaking AI technology, we would love to hear from you. Join us in transforming Utilization Management through AI. Your expertise could shape the future! Job Types: Part-time, Contract, Temporary, Temp-to-hirePay: $75-$100 per hourExpected hours: No more than 5 per weekSchedule:• Monday to FridayExperience:• Utilization Management: 2 years (Required)License/Certification:• RN License (Required)Work Location: RemoteJob Types: Part-time, ContractPay: $75.00 - $100.00 per hourExperience:• Clinical Audit: 2 years (Required)License/Certification:• RN License (Required)Work Location:Remote Apply tot his job