Remote RN - Utilization Review & Case Assessments

Oscar Health; United States; Remote; USD 48.000 - 62.000; Vollzeit

Benefits dieser Stelle

15 days vacation per year

Benefits package

Remote work flexibility

Zusammenfassung

Oscar Health is seeking a Utilization Review Nurse to join our team. You will review cases, verify medical records, and consult with care providers to assess treatment appropriateness using Oscar Clinical Guidelines, MCG, and InterQual.

The role reports to the Supervisor, Utilization Review. This remote position is open to multiple states with occasional travel for meetings and events. The base pay ranges from $35.00 to $45.94 per hour, plus benefits and vacation accrual.

Qualifikationen

• Active, unrestricted RN licensure in the US or compact multistate license.
• Associate degree in nursing or nursing diploma; BSN preferred.
• Ability to obtain additional state licenses as needed.
• 1+ year of utilization review experience in managed care.
• Experience with MCG or InterQual guidelines.
• 1+ year clinical practice in acute care (ER or hospital).
• Weekend availability required; at least one weekend day per week.

Aufgaben

• Perform medical necessity and level of care reviews.
• Gather necessary information via phone and fax to assess clinical conditions.
• Apply evidence-based guidelines to determine care appropriateness.
• Meet required decision-making SLAs and refer for further engagement when needed.
• Ensure compliance with applicable laws and regulations.

Kenntnisse

RN license

Utilization review

MCG familiarity

InterQual familiarity

Clinical experience

Weekend availability

Ausbildung

RN license (US)

Associate degree in nursing or nursing diploma

BSN

Tools

Milliman Care Guidelines

InterQual

Jobbeschreibung

Oscar Health is seeking a Utilization Review Nurse to join our team. You will review cases, verify medical records, and consult with care providers to assess treatment appropriateness using Oscar Clinical Guidelines, MCG, and InterQual.

The role reports to the Supervisor, Utilization Review. This remote position is open to multiple states with occasional travel for meetings and events. The base pay ranges from $35.00 to $45.94 per hour, plus benefits and vacation accrual.