Nurse Supervisor, UM Clinical Quality

Oscar Health

1d•Remote

About The Position

You will provide day-to-day oversight and management of the team. You will also own daily Nurse team operations, including queue and volume throughput and staffing, and also serve as the primary escalation point for your teams. You will support strategic and clinical initiatives as needed. You will report into the Manager, Clinical Programs Work Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; or Texas. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events. #LI-Remote Pay Transparency: The base pay for this role is: $91,908 - $120,629 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program, and annual performance bonuses.

Requirements

Active, unrestricted Registered Nurse (RN) licensure from the United States and in the state of hire, OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC)
Associate Degree and/or Bachelors of Nursing from an accredited school of nursing
5+ years healthcare experience (including at least 2 years clinical practice in an acute care setting)
3+ years of utilization review experience at a managed care plan or provider organization
1+ years of direct-report leadership of a clinical team at a managed care plan or healthcare organization including in a virtual environment.
A working knowledge of health insurance/benefit concepts - Medicare and Individual Marketplace insurance experience preferred.

Nice To Haves

Experience in healthcare quality assurance
Strong understanding of NCQA accreditation standards for utilization management, case management or population health, HEDIS measures and other regulatory requirements
CCM or MCG certification
Experience analyzing and interpreting performance and other forms of data
Proficiency using Google Suite

Responsibilities

Own daily workforce management, including staffing and queue assignments, PTO/leave, and payroll/compensation.
Manage queue on a daily basis, ensuring compliance with regulatory timelines, staff coverage, and coordination with internal teams for forecasting and timely handling of ad hoc escalations
Ensure team adheres to department policies and workflows and serve as continual champion of the Oscar mission.
Drive and own the success of clinical auditing and performance through ongoing evaluations; effectively use Oscar tools to monitor and trend nurse productivity and auditing data for assessment and reporting.
Support the onboarding and training of newly-hired clinicians and partner with the Clinical Quality & Training team on the development and maintenance of clinical training and resource material.
Partner with the Talent Acquisition team on clinical hiring initiatives.
Complete medical necessity and level of care reviews using clinical judgment and the Plan's designated clinical guidelines, if applicable.
Comply with department performance and quality metrics, and adhere to training and remediation requirements.
Compliance with all applicable laws and regulations (DO NOT REMOVE - REQUIRED)
Other duties as assigned (DO NOT REMOVE - REQUIRED)