πUnited States
Utilization Review Nurse
closed
Oscar
π΅ $72k-$95k
πRemote - Worldwide
Summary
Join Oscar's Clinical Review team as a Utilization Review Registered Nurse! You will perform case reviews, check medical records, and communicate with care providers to assess treatment appropriateness. Your recommendations will be based on research and evidence-based guidelines. This role reports to the Utilization Review Supervisor and offers a blended work culture with remote options available for those outside of commuting distance to our NYC, Tempe, or Los Angeles offices. The base pay is $35.00-$45.94 per hour, and you'll be eligible for employee benefits. You must reside in one of the specified states and possess relevant experience and qualifications.
Requirements
- 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 Or Successful completion of Diploma Program in Practical Nursing 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)
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
- Meet required decision-making Service level agreements
- Refer members for further care engagement when needed
- Compliance with all applicable laws and regulations
- Work schedule includes one weekend day per week
- Other duties as assigned
Preferred Qualifications
- BSN
- Previous experience conducting concurrent or inpatient reviews for a managed care plan
Benefits
- Medical, dental, and vision benefits
- 11 paid holidays
- Paid sick time
- Paid parental leave
- 401(k) plan participation
- Life and disability insurance
- Paid wellness time and reimbursements
This job is filled or no longer available
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