Utilization Review Registered Nurse

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

About the role

Perform frequent case reviews, check medical records and speak with care providers regarding treatment as needed.  They also make recommendations regarding the appropriateness of care for identified diagnoses based on the research results for those conditions.

You will report to the Utilization Review Supervisor. 

This is a work-from-home/remote role. You must reside in one of the following states: Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Iowa, Maryland, Massachusetts, Michigan, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, Tennessee, Texas, Utah, Virginia, Washington, or Washington, D.C. Note, this list of states is subject to change.

The base pay for this role is: $35 - $45.94 per hour. You are also eligible for employee benefits, monthly vacation accrual up to 10 days per year participation.

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 SLAs
• Refer members for further care engagement when needed
• Compliance with all applicable laws and regulations 
• Other duties as assigned 

Qualifications

• 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)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)
• 1+ years experience with medical decision support tools (i.e. Interqual, MCG, NCCN)

Bonus Points

• BSN
• Previous experience conducting concurrent or inpatient reviews for a managed care plan