Healthcare Operations Director | Remote
CuraSenseAI · United States · 3 wk ago
RemoteRemoteManagement$100–$150/hrContract
Role Overview
What You Will Be Doing
- Review and assess medical necessity determinations, clinical reviews, and utilization management recommendations
- Evaluate admission, continued stay, discharge planning, and level-of-care decisions against established clinical criteria
- Support physician advisor workflows, peer-to-peer reviews, and denial management processes
- Analyze care coordination and transition-of-care activities to improve operational effectiveness
- Provide structured feedback on clinical review outputs, compliance standards, and utilization management practices
Who We Are Looking For
- Active RN or physician license with strong utilization management, case management, or clinical review expertise
- Experience leading utilization management, care coordination, or case management operations
- Deep knowledge of InterQual, MCG, Milliman, or comparable clinical review frameworks
- Strong understanding of medical necessity review, observation status regulations, and payer requirements
- Excellent analytical, documentation review, and stakeholder communication skills
Role Details
- Compensation: $100-$150 per hour
- Work style: Fully remote, flexible independent contract
- Duration: Ongoing project-based engagement
How To Apply
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