Utilization Review Nurse (Fully Remote)

Oscar Health; United States; À distance; USD 70 000 - 90 000; Plein temps

Avantages offerts par ce poste

Medical insurance

Dental insurance

Vision insurance

401(k)

Paid parental leave

Résumé du poste

Oscar Health is seeking an experienced Registered Nurse to perform complete medical necessity reviews and determine level of care for requested services.

You will collect information by phone and fax, apply MCG or InterQual guidelines, and ensure timely decisions, meeting SLAs and referring members for further care engagement. Weekend availability is required; we value an inclusive environment and offer comprehensive benefits including medical, dental, vision, and a 401(k).

Qualifications

• Active RN license in good standing.

Responsabilités

• Complete medical necessity reviews and level of care determinations.
• Obtain information via phone and fax to assess member condition.
• Meet decision-making SLAs and refer members for further care engagement.

Connaissances

Utilization review experience

Managed care experience

InterQual/MCG guidelines knowledge

Clinical experience in acute care

Formation

RN licensure (unrestricted)

Compact multistate license

Outils

InterQual

MCG

Description du poste

• Complete medical necessity reviews and level of care reviews for requested services.
• Obtain necessary information via phone and fax to assess member's condition and apply guidelines.
• Meet required decision-making SLAs and refer members for further care engagement.

Requirements:

• Active unrestricted RN licensure or compact multistate license.
• 1+ year of utilization review experience in managed care.
• Strong experience with MCG or InterQual. 1+ years clinical experience in acute care.
• Weekend availability required.
• Oscar fosters an inclusive environment where authenticity is valued.
• We offer medical, dental, vision, 401(k), paid parental leave, and more.
• We are an equal opportunity employer.

Oscar Health

Oscar Health is a technology-driven health insurance company focused on simplifying healthcare for its members. We are a mission-driven organization with a diverse team, committed to innovation and equity in healthcare.