Utilization Review Nurse

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

Oscar is the first health insurance company built around a full stack technology platform and a 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

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

You will report to the Utilization Review Supervisor.

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Work Location:

Oscar is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture and our mission.

If you live within commutable distance to our New York City office (in Hudson Square), our Tempe office (off the 101 at University Dr), or our Los Angeles office (in Marina Del Rey), you will be expected to come into the office at least two days each week. Otherwise, this is a remote / work-from-home role.

You must reside in one of the following states: Alabama, Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Iowa, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, Virginia, Washington, or Washington, D.C. Note, this list of states is subject to change. #LI-Remote

Pay Transparency:

The base pay for this role is: $35.00 - $45.94 per hour. You are also eligible for employee benefits, monthly vacation accrual at a rate of 10 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 Service level agreements
• Refer members for further care engagement when needed
• Compliance with all applicable laws and regulations
• Work schedule includes one weekend day per week
• Other duties as assigned

Qualifications

• Active, unrestricted RN licensure from the United States 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 Diploma Program in Practical Nursing of 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
• 2+ 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