Utilization Review Nurse • Mid-Level

Who you are

You are a dedicated healthcare professional with experience in utilization review or a related field. You possess strong clinical judgment and are comfortable reviewing medical records and engaging with care providers. Your ability to make informed recommendations regarding treatment appropriateness is key to your success in this role. You are detail-oriented and have excellent communication skills, allowing you to effectively collaborate with team members and stakeholders. You understand the importance of compliance with clinical guidelines and decision-making standards in healthcare. You are adaptable and willing to travel occasionally for team meetings and company events.

What you'll do

As a Utilization Review Nurse at Oscar, you will conduct frequent case reviews to ensure that members receive appropriate care based on their diagnoses. You will check medical records and communicate with care providers to gather necessary information for your assessments. Your role will involve applying Oscar Clinical Guidelines and Milliman Care Guidelines to determine medical necessity and level of care for requested services. You will be responsible for meeting decision-making service level agreements (SLAs) and referring members for further care engagement when necessary. Your contributions will help maintain high standards of care and support Oscar's mission of serving its members effectively.

What we offer

Oscar provides a competitive hourly wage ranging from $35.00 to $45.94, along with employee benefits and a monthly vacation accrual rate of 15 days per year. You will have the opportunity to work remotely while being part of a team that values collaboration and innovation in the healthcare industry. Oscar is committed to creating a supportive work environment that encourages professional growth and development. You will be part of a company that prioritizes the well-being of its members and strives to redefine the health insurance experience.