Utilization Review Nurse

closed
Oscar Logo

Oscar

πŸ’΅ $72k-$95k
πŸ“Remote - 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

Similar Remote Jobs