Utilization Review Nurse (Remote)

Hi, we're Oscar. We’re hiring a Utilization/Clinical Review Nurse to join our Clinical team. 

Oscar is a technology-driven, consumer-focused health insurance startup founded in 2012 and headquartered in New York City. Our goal is to make health insurance simple, transparent, and human. We need your help to do so.

About the role:

We're looking for experienced clinicians to join the fast-growing Utilization Management/Clinical Review team . We're working to bring a new level of service to utilization review and ensure Oscar members receive access to appropriate care in a timely, transparent way. 

As a Utilization/Clinical Review Nurse, you will determine the medical appropriateness of inpatient and outpatient services by reviewing clinical information and applying evidence-based guidelines. You will also interact with Oscar providers, members, and internal service team to obtain necessary information and communicate approval determinations.

You will report into the Utilization Review Nurse Manager

Responsibilities:

Collect relevant medical information (via telephone and fax) and apply the appropriate evidence-based guidelines and medical policy

Meet required decision-making timeframes, including promptly triggering escalation for cases requiring physician review

Clearly document all communication and decision-making within our utilization review tracking platform, ensuring a peer could easily reference and understand your decision

Develop a working familiarity with applicable regulatory and accreditation requirements 

Maintain continued professional growth and education to meet continuing education requirements and demonstrate knowledge & understanding of current nursing care practice

Requirements:

2+ years utilization review experience at a managed care plan or provider organization 

5+ years healthcare experience (including at least 2 years clinical practice in an acute care setting, i.e., ER or hospital)

Active, unrestricted RN or LVN license and willingness to obtain additional state licenses as needed for Oscar's growth (with Oscar's support)

Bonus Points

BSN preferred

Life at Oscar: 

At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.

We aim to make health care affordable and accessible for all, and apply this same vision to our perks and benefits, including: medical benefits, unlimited paid-time off, paid parental leave, retirement plans, company social events, stocked kitchens, wellness programs, and volunteer opportunities.