Utilization Review Nurse

<p>Hi, we're Oscar. We're hiring a Utilization Review Nurse to join our Utilization Review team.</p> <p>Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.</p> <p><strong>About the role:</strong></p> <p>You will perform frequent case reviews, check medical records and speak with care providers regarding treatment as needed. You will make recommendations regarding the appropriateness of care for identified diagnoses based on the research results for those conditions.</p> <p>You will report into the Supervisor, Utilization Review.</p> <p><strong>Work Location: </strong>This is a remote position, open to candidates who reside in: Texas, Georgia, Arizona, and Florida. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events. #LI-Remote</p> <p><strong>Pay Transparency: </strong>The base pay for this role is: $35.00 - $45.94 per hour. You are also eligible for employee benefits and monthly vacation accrual at a rate of 15 days per year.</p> <p><strong>Responsibilities:</strong></p> <ul> <li>Complete medical necessity reviews and level of care reviews for requested services using clinical judgment and Oscar Clinical Guidelines, Milliman Care Guidelines</li> <li>Obtain the information necessary (via telephone and fax) to assess a member's clinical condition, and apply the appropriate evidence-based guidelines</li> <li>Meet required decision-making SLAs</li> <li>Refer members for further care engagement when needed</li> <li>Compliance with all applicable laws and regulations</li> <li>Other duties as assigned</li> </ul> <p><strong>Requirements:</strong></p> <ul> <li>Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC)</li> <li>Associate Degree or Bachelors Degree - Nursing or Graduate of Accredited School of Nursing</li> <li>MCG or InterQual tooling experience</li> <li>Ability to obtain additional state licenses to meet business needs</li> <li>1+ year of utilization review experience in a managed care setting</li> <li>1+ years of clinical experience (including at least 1+ year clinical practice in an acute care setting, i.e., ER or hospital)</li> </ul> <p><strong>Bonus points:</strong></p> <ul> <li>BSN</li> <li>Previous experience conducting concurrent or inpatient reviews for a managed care plan</li> </ul><div class="content-conclusion"><p><span style="font-weight: 400;">This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud</span><a href="http://hioscar.com/careers/recruitment-fraud-alert"><span style="font-weight: 400;"> </span><span style="font-weight: 400;">here</span></a><span style="font-weight: 400;">. </span></p> <p><span style="font-weight: 400;">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.</span></p> <p><strong>Pay Transparency: </strong><span style="font-weight: 400;">Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. </span><span style="font-weight: 400;">Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.</span></p> <p><span style="font-weight: 400;"><str ... (truncated, view full listing at source)