Senior Clinical Quality Nurse — Remote Impact

Namely; United States; Remote; USD 75.000 - 110.000; Vollzeit

Benefits dieser Stelle

Medical insurance

Dental insurance

Vision benefits

401(k)

Zusammenfassung

Oscar Health seeks a Senior Clinical Quality Nurse to advance clinical outcomes and member care through audits of services from providers, facilities, and Oscar staff. You will mentor peers and implement audit programs aligning with regulatory requirements, reporting to the Nurse Supervisor, UM Clinical Quality.

This remote role covers multiple US states with occasional travel for team meetings and events, and offers performance bonuses and generous benefits.

Qualifikationen

• Active RN license in home state or willing to obtain additional licenses.
• 2+ years as a Registered Nurse in a clinical setting.
• 1+ year in utilization review or related managed care experience.

Aufgaben

• Perform quality audits on clinical documentation across departments.
• Develop audit surveys and rubrics for transparent audits.
• Pull cases for auditing and track results in systems.
• Prepare for NCQA and other regulatory audits.
• Write audit summaries and present to stakeholders.
• Provide coaching and training on quality best practices.
• Collaborate on audit trends and quality data reporting.
• Participate in calibration sessions to ensure consistency.
• Support IRR processes for consistent clinical decisions.

Kenntnisse

Clinical audit

Quality improvement

Regulatory knowledge

Data interpretation

Google Workspace

Ausbildung

BSN (preferred)

RN license

CCM/MCG certification

Tools

Google Sheets

Google Docs

Google Meets

Jobbeschreibung

Oscar Health seeks a Senior Clinical Quality Nurse to advance clinical outcomes and member care through audits of services from providers, facilities, and Oscar staff. You will mentor peers and implement audit programs aligning with regulatory requirements, reporting to the Nurse Supervisor, UM Clinical Quality.

This remote role covers multiple US states with occasional travel for team meetings and events, and offers performance bonuses and generous benefits.