Utilization Review RN — Care Pathway & Outcomes Leader

Oscar Health; United States; Remote; USD 70.000 - 90.000; Vollzeit

Benefits dieser Stelle

Medical insurance

Dental insurance

Vision insurance

401(k)

Paid parental leave

Zusammenfassung

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).

Qualifikationen

• Active RN license in good standing.

Aufgaben

• 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.

Kenntnisse

Utilization review experience

Managed care experience

InterQual/MCG guidelines knowledge

Clinical experience in acute care

Ausbildung

RN licensure (unrestricted)

Compact multistate license

Tools

InterQual

MCG

Jobbeschreibung

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).