Utilization Review Nurse

Oscar Health

🔍 Observed

$35 - $46 USD

Remote First seen 3 weeks, 1 day ago Last seen 3 hours, 57 minutes ago Greenhouse

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Job Description

AI Summary

• Perform medical necessity and level of care reviews for health insurance members using clinical guidelines, medical records review, and provider communication to assess treatment appropriateness • Must hold active unrestricted RN license in Texas, Georgia, Arizona, or Florida (or multistate compact license) with 1+ years utilization review experience in managed care and 1+ years acute care clinical experience • Remote position based in TX, GA, AZ, or FL with occasional travel required; reports to Utilization Review Supervisor and must meet decision-making service level agreements • Compensation of $35.00-$45.94 per hour with employee benefits, 15 days vacation accrual annually, and eligibility for additional state licensure reimbursement as needed • Preferred qualifications include BSN degree and prior concurrent or inpatient review experience; MCG or InterQual tooling experience required

Hi, we're Oscar. We're hiring a Utilization Review Nurse to join our Utilization Review team.

Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.

About the role:

You will perform frequent case reviews, check medical records and speak with care providers regarding treatment as needed. You will make recommendations regarding the appropriateness of care for identified diagnoses based on the research results for those conditions.

You will report into the Supervisor, Utilization Review.

Work Location: This is a remote position, open to candidates who reside in: Texas, Georgia, Arizona, and Florida. 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: $35.00 - $45.94 per hour. You are also eligible for employee benefits and 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 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

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)

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 discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're 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. Full-time 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.

Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.

Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant’s disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known.

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 Privacy Policy.

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Job Information

Company:
Oscar Health
Location:
Remote
Work Location:
Remote
Experience Level:
Mid
Source:
Greenhouse
Status:
Active

Activity Score

65 /100

Likely Active (65)

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