[Remote] Healthcare Operations Director | Remote

Note: The job is a remote job and is open to candidates in USA. CuraSenseAI is a healthcare company focused on optimizing operations in clinical review and utilization management. They are seeking a Healthcare Operations Director to leverage their expertise in evaluating clinical workflows and care coordination processes.

Responsibilities

• 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

Skills

• 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

Benefits

• Fully remote, flexible independent contract

Company Overview

• CuraSenseAI connects healthcare professionals with high-quality remote and global opportunities across healthcare, life sciences, and AI-driven medical domains. It was founded in undefined, and is headquartered in , with a workforce of 2-10 employees. Its website is https://www.curasenseai.com.