Utilization Review Nurse
Utilization Review Nurse
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Job Description
Hi were Oscar. Were hiring a Utilization Review Registered Nurse to join our Clinical Review team.
Oscar is the first health insurance company built around a full stack technology platform and a focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselvesone that behaves like a doctor in the family.
About the role
As the Utilization Nurse you will perform frequent case reviews check medical records and speak with care providers regarding treatment. You will also make recommendations regarding the appropriateness of care for identified diagnoses based on the research results for those conditions.
You will report to the Utilization Review Supervisor.
Work Location:
Oscar is a blended work culture where everyone regardless of work type or location feels connected to their teammates our culture and our mission.
If you live within commutable distance to our New York City office (in Hudson Square) our Tempe office (off the 101 at University Dr) or our Los Angeles office (in Marina Del Rey) you will be expected to come into the office at least two days each week. Otherwise this is a remote / workfromhome role.
You must reside in one of the following states: Alabama Arizona Colorado Connecticut Florida Georgia Illinois Iowa Kentucky Maine Maryland Massachusetts Michigan Minnesota Missouri Nevada New Hampshire New Jersey New Mexico New York North Carolina Ohio Oregon Pennsylvania Rhode Island South Carolina Tennessee Texas Utah Vermont Virginia Washington or Washington D.C. Note this list of states is subject to change. #LIRemote
Pay Transparency:
The base pay for this role is: $35.00 $45.94 per hour. You are also eligible for employee benefits monthly vacation accrual at a rate of 15 days per year.
Responsibilities
- Complete medical necessity reviews and level of care reviews for requested services using clinical judgment and Oscar Clinical Guidelines Milliman Care Guidelines
- Obtain the information necessary (via telephone and fax) to assess a members clinical condition and apply the appropriate evidencebased guidelines
- Meet required decisionmaking Service level agreements
- Refer members for further care engagement when needed
- Compliance with all applicable laws and regulations
- Work schedule includes one weekend day per week
- Other duties as assigned
Qualifications
- Active unrestricted RN licensure from the United States OR active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC)
- Associate Degree Nursing or Graduate of Accredited School of Nursing Or Successful completion of Diploma Program in Practical Nursing of Accredited School of Nursing
- Ability to obtain additional state licenses to meet business needs
- 1 year of utilization review experience in a managed care setting
- 2 years of clinical experience (including at least 1 year clinical practice in an acute care setting i.e. ER or hospital)
Bonus Points
- BSN
- Previous experience conducting concurrent or inpatient reviews for a managed care plan
This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here.
At Oscar being an Equal Opportunity Employer means more than upholding discriminationfree hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. Were on a mission to change health care an experience made whole by our unique backgrounds and perspectives.
Pay Transparency: Final offer amounts within the base pay set forth above are determined by factors including your relevant skills education and experience. Fulltime employees are eligible for benefits including: medical dental and vision benefits 11 paid holidays paid sick time paid parental leave 401(k) plan participation life and disability insurance and paid wellness time and reimbursements.
Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications without regard to applicants disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team to make the need for an accommodation known.
Artificial Intelligence (AI) Guidelines: Please see our AI Guidelines for the acceptable use of artificial intelligence during the interview process at Oscar.
California Residents: For information about our collection use and disclosure of applicants personal information as well as applicants rights over their personal information please see our Notice to Job Applicants.
Employment Type
Hourly
