Utilization Review Nurse, BPO Supervisor
About The Position
You will provide daily oversight and management of the team. You will own the daily Nurse off-shore team operations, including queue and volume throughput and staffing, and also serves as the primary escalation point for their teams. You will supports strategic and clinical initiatives. You will report into the Manager, Utilization Review. Work Location:This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois; Iowa; Kansas; Michigan; Missouri; Nebraska; New Jersey; North Carolina; Ohio; Oklahoma; Pennsylvania; South Carolina; Tennessee; Texas; or Virginia. 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: $91,980 - $120,629 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program, and annual performance bonuses.
Requirements
- 3+ years of utilization review experience at a managed care plan or provider organization
- 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)
- 2 + years of off-shore managing vendor experience
- 2+ year of leadership experience
- 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)
- Milliman (MCG) experience
Nice To Haves
- Bachelors of Nursing (BSN) degree
- Masters of Science in Nursing (MSN) degree, or MBA/Healthcare administration degree
- Project management certification (e.g. Six Sigma, SCRUM, Agile)
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 on-shore 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
- Other duties as assigned
Benefits
- employee benefits
- participation in Oscar's unlimited vacation program
- annual performance bonuses
- medical, dental, and vision benefits
- 11 paid holidays
- paid sick time
- paid parental leave
- 401(k) plan participation
- life and disability insurance
- paid wellness time and reimbursements
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What This Job Offers
Job Type
Full-time
Career Level
Manager
Education Level
Associate degree
Number of Employees
1-10 employees
