Utilization Review Nurse

Oscar Health

4h • Remote

About The Position

Oscar is hiring a Utilization Review Nurse to join their Utilization Review team. Oscar is the first health insurance company built around a full stack technology platform with a relentless focus on serving its members. The Utilization Review Nurse will perform frequent case reviews, check medical records, and speak with care providers regarding treatment as needed. They will make recommendations regarding the appropriateness of care for identified diagnoses based on research results for those conditions. This position reports to the Supervisor, Utilization Review. It is a remote position open to candidates residing in Texas, Georgia, Arizona, and Florida, with occasional travel required for team meetings and company events.

Requirements

• Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC)
• Associate Degree or Bachelors Degree - Nursing or Graduate of Accredited School of Nursing
• MCG or InterQual tooling experience
• Ability to obtain additional state licenses to meet business needs
• 1+ year of utilization review experience in a managed care setting
• 1+ years of clinical experience (including at least 1+ year clinical practice in an acute care setting, i.e., ER or hospital)

Nice To Haves

• BSN
• Previous experience conducting concurrent or inpatient reviews for a managed care plan

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 member's clinical condition, and apply the appropriate evidence-based guidelines
• Meet required decision-making SLAs
• Refer members for further care engagement when needed
• Compliance with all applicable laws and regulations
• Other duties as assigned

Benefits

• employee benefits
• monthly vacation accrual at a rate of 15 days per year
• medical benefits
• dental benefits
• vision benefits
• 11 paid holidays
• paid sick time
• paid parental leave
• 401(k) plan participation
• life and disability insurance
• paid wellness time and reimbursements

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree
• Number of Employees: 1-10 employees