Freelance Utilization Management Nurse

About the role

Deccan AI Experts is seeking a Freelance Utilization Management Nurse to evaluate AI‑generated utilization review decisions, medical necessity assessments, and related healthcare documentation. This remote role supports the improvement of AI systems used in healthcare operations, clinical decision support, and payer workflows.

Key responsibilities

• Review AI‑generated utilization review reports, prior authorization determinations, case summaries, appeal documentation, discharge plans, and clinical recommendations.
• Evaluate medical necessity using InterQual®, MCG, CMS, and payer‑specific guidelines.
• Verify AI recommendations for admission status, level of care, continued stay reviews, and resource utilization.
• Identify documentation deficiencies, coding inconsistencies, compliance issues, and patient safety concerns.
• Provide structured feedback to improve AI performance in utilization management and healthcare operations.
• Review peer‑developed deliverables to maintain quality and consistency standards.

Required profile

• Active RN license in the applicable country or state.
• BSN or ADN from an accredited nursing program.
• 3+ years of hands‑on experience in utilization management, utilization review, case management, managed care, health insurance, or hospital care coordination.
• Experience applying InterQual®, MCG, CMS, and payer‑specific guidelines to determine appropriate levels of care.

Required skills

• Knowledge of InterQual® utilization management criteria.
• Familiarity with MCG (Milliman Care Guidelines).
• Understanding of CMS regulations and payer‑specific guidelines.