Remote Utilization Review Nurse - Evidence-Based Care

Namely; United States; Remote; USD 48,000 - 63,000; Full time

Benefits offered by this job

Medical, dental, vision benefits

11 paid holidays

Paid wellness time and reimbursements

Job summary

Oscar Health is seeking a Utilization Review Nurse to perform medical necessity and level of care reviews from a home office. You will gather information by phone/fax, apply guidelines, and coordinate with care providers to determine appropriate care for identified conditions.

The role requires an active US RN license, at least 1 year in utilization review within managed care, and weekend availability. This is a remote position with optional travel for meetings.

Qualifications

• Active, unrestricted RN licensure in the United States or a compact multistate license.
• Associate Degree in Nursing or Nursing Diploma program completion.
• Ability to obtain additional state licenses to meet business needs.
• 1+ year of utilization review experience in a managed care setting.

Responsibilities

• Perform medical necessity reviews and level of care reviews for requested services.
• Obtain necessary information via telephone and fax to assess clinical condition.
• Meet required decision-making SLAs and refer members for further care when needed.
• Ensure compliance with applicable laws and regulations.

Skills

Utilization review

Clinical judgement

Communication

Education

RN licensure (US or compact)

Associate Degree in Nursing or Nursing Diploma

Ability to obtain additional state licenses

Tools

MCG Milliman Care Guidelines

InterQual

Job description

Oscar Health is seeking a Utilization Review Nurse to perform medical necessity and level of care reviews from a home office. You will gather information by phone/fax, apply guidelines, and coordinate with care providers to determine appropriate care for identified conditions.

The role requires an active US RN license, at least 1 year in utilization review within managed care, and weekend availability. This is a remote position with optional travel for meetings.