[Hiring] Utilization Review Nurse @Oscar Health

Role Description

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

About the role:

• Perform frequent case reviews, check medical records, and speak with care providers regarding treatment as needed.
• Make recommendations regarding the appropriateness of care for identified diagnoses based on research results for those conditions.
• Report into the Supervisor, 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; Pennsylvania; South Carolina; Tennessee; Texas; or Virginia.
• Occasional travel may be required for team meetings and company events.

Pay Transparency:

• The base pay for this role is: $35.00 - $45.94 per hour.
• 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.

Qualifications

• 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 - Nursing or Graduate of Accredited School of Nursing Or Successful completion of Nursing Diploma Program in 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.
• Strong experience utilizing MCG (Milliman Care Guidelines) or InterQual.
• 1+ years of clinical experience (including at least 1+ year clinical practice in an acute care setting, i.e., ER or hospital).
• Weekend availability is required; all applicants must be able to work at least one weekend day (Saturday or Sunday) each week.

Bonus points:

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

Benefits

• 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.
• Paid wellness time and reimbursements.

Company Description

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.