Utilisation Management Clinical AI Reviewer

About OpenTrain

OpenTrain AI is the hiring and contracting organization for this role. OpenTrain is the leading platform for finding and building careers in AI training and data labeling, helping specialists discover projects, build a professional profile, and apply in minutes.

This opportunity lets experienced clinical professionals contribute to AI systems while developing a lasting portfolio of specialized AI training work.

• Remote contract work for candidates located in the United States
• Part-time schedule with a default commitment of 20 hours per week
• Hourly pay of $100 to $150

About Clinical AI Training

AI training is the human side of building artificial intelligence. Experienced professionals review model outputs, identify errors, and provide structured feedback so AI systems become more accurate, useful, and appropriate in real-world workflows.

In healthcare, clinical reviewers help evaluate medical content, decision-support recommendations, and documentation against established professional and regulatory standards. Your expertise can directly shape how AI supports clinical review and care coordination.

• Evaluate and rate AI-generated content using professional judgment
• Apply specialized clinical knowledge to improve training data
• Work remotely with flexible, part-time scheduling

The Role

OpenTrain AI is recruiting a Utilisation Management Clinical AI Reviewer to evaluate AI tools used in clinical review, medical-necessity determination, and care-coordination workflows. You will review AI-generated medical-necessity determinations, clinical review outputs, and utilisation management decision-support recommendations for accuracy and clinical appropriateness.

The work is grounded in utilisation management and case management practice, with direct attention to admission, continued-stay, and level-of-care decisions. You will also provide structured clinical feedback that helps improve AI training datasets.

• Role level: Expert
• Employment type: Contractor and part-time
• Language: English
• Location: United States

What You'll Do

You will apply clinical review judgment across concurrent and retrospective review, discharge planning, transitions of care, and physician advisor support. Your evaluations will help assess whether AI-generated outputs are accurate, clinically appropriate, and aligned with applicable review criteria.

• Review AI-generated utilisation management and case management outputs
• Evaluate medical-necessity decisions, care-coordination recommendations, and clinical review summaries
• Compare review outputs against InterQual, MCG, or Milliman criteria
• Support physician advisor workflows, peer-to-peer review requests, and denial appeals
• Annotate AI outputs with structured clinical feedback for training use
• Apply UM and CM judgment across concurrent review, retrospective review, discharge planning, and transitions of care
• Consider CMS Conditions of Participation, the Two-Midnight Rule, and payer UM requirements

Required Qualifications

This role requires senior experience in utilisation management, case management, or clinical review. An active RN licence is required, while physician advisor or MD experience is preferred.

You should be comfortable reviewing detailed clinical documentation and assessing AI-generated outputs against established criteria, payer requirements, and appropriate clinical standards.

• Senior utilisation management, case management, or clinical review experience
• Active RN licensure required, or a physician advisor or MD background
• Hands-on knowledge of InterQual, MCG, or Milliman clinical review criteria
• Familiarity with the CMS Two-Midnight Rule, observation status, and inpatient criteria
• Experience with physician advisor programs and payer peer-to-peer review
• Experience with denial appeals and physician advisor workflows
• Strong written and verbal English communication skills
• Careful attention to clinical documentation and AI-generated outputs

Helpful Background

The following experience can help you succeed in this specialised clinical AI review role, though it is not listed as required.

• CPUR, ACM, or CCM credential
• Experience in health systems, ACOs, or value-based care UM programs
• Comfort evaluating AI-generated clinical review content
• Familiarity with UM software platforms such as Allscripts or similar

Schedule, Pay, and Application

This remote contractor opportunity is available to U.S.-based candidates with a default commitment of 20 hours per week. Compensation is $100 to $150 per hour, based on the role's stated pay range.

Create a free OpenTrain account to build your profile and apply through OpenTrain. Your experience in utilisation management and clinical review can help shape how emerging AI tools support healthcare workflows.

• Pay: $100 to $150 per hour
• Time requirement: 20+ hours per week
• Work arrangement: Remote
• Eligible location: United States
• Apply through OpenTrain