Utilization Review Nurse Clinical

Oscar Health Insurance; Mississippi; Remote; USD 10,000 - 60,000; Full time

Job summary

An innovative health insurance company is seeking a Utilization Review Registered Nurse to join their Clinical Review team. This role involves performing case reviews, checking medical records, and collaborating with care providers to ensure appropriate treatment recommendations. The company fosters a blended work culture, allowing flexibility in remote work while maintaining strong connections among teammates. With a focus on member care and a commitment to a supportive environment, this position offers an exciting opportunity to impact healthcare positively.

Benefits

Medical, dental, and vision benefits

401(k) plan participation

Paid parental leave

Paid sick time

Paid wellness time and reimbursements

11 paid holidays

Monthly vacation accrual

Qualifications

• Active RN licensure required.
• 1+ year of utilization review experience in managed care.

Responsibilities

• Complete medical necessity reviews using clinical judgment.
• Obtain information to assess member's clinical condition.

Skills

Utilization Review

Clinical Judgment

Communication Skills

Education

Associate Degree in Nursing

BSN

Job description

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.

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, 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 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
• 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 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
• 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

This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here .

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.

Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. 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, and paid wellness time and reimbursements.

Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant’s disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team ([e-mail]) to make the need for an accommodation known.

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