Utilization Management Nurse - AI Evaluation

What You'll Do5

• Create challenging clinical tasks and longitudinal chart scenarios that mirror real utilization management decisions.
• Write reference answers and evaluation rubrics for prior authorization, medical necessity, and payer appeal cases.
• Assess model responses by checking clinical reasoning, documentation quality, and patient safety.
• Synthesize fragmented patient records, flag contradictions or missing actions, and judge the clinical defensibility of conclusions.
• Apply structured rubrics, review specialist feedback, and refine cases through calibration cycles.

Requirements6

• At least 3 years of relevant professional experience, with current practice or practice within the last three years.
• An active RN license or another recognized credential suited to utilization management nursing.
• A relevant healthcare degree or equivalent practical experience.
• Strong clinical reasoning, chart-review, documentation, and written communication skills.
• A record of reaching defensible clinical conclusions with attention to patient safety.
• Ability to follow standardized rubrics, absorb critique, and work through review and calibration cycles.

Preferred Qualifications2

• Familiarity with US clinical guidelines, payer policies, regulatory requirements, and healthcare workflows.
• Experience with AI evaluation, clinical content or assessment development, expert review, or quality improvement.

Who Should Apply

A utilization management nurse with an active RN license and 3+ years of relevant experience fits this contract. Chart review, clinical reasoning, and rubric-based evaluation form the core of the work.

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