Utilization Review Nurse

Summary

Join Oscar's Clinical Review team as a Utilization Review Registered Nurse and perform frequent case reviews, checking medical records and consulting with care providers about treatment. You will make recommendations on care appropriateness based on research. This role reports to the Utilization Review Supervisor and offers a blended work culture with a remote option for those outside commuting distance of our NYC, Tempe, or LA offices. The base pay is $35.00-$45.94 per hour, and you'll be eligible for employee benefits and monthly vacation accrual. You must reside in one of the listed states and hold an active, unrestricted RN license. This position requires utilization review experience in a managed care setting and clinical experience in an acute care setting.

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
• 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