Senior Quality of Care Review Nurse

Responsibilities

• Perform quality audits of internal and external member, provider, and delegated vendor interactions
• Guide interrater reliability (IRR) assessments to support evidence-based clinical decision-making
• Investigate provider and facility quality of care concerns and escalate negative performance trends
• Consult with company partners to ensure programs meet organizational needs and regulatory requirements
• Present quality and performance trend data to organizational partners and quality subcommittees
• Collaborate on corrective action plans to address identified clinical gaps

Requirements

• Licensed Registered Nurse with an active, unrestricted license in your state of residence
• 2+ years of experience as a Registered Nurse
• 2+ years of experience working in a clinical care setting
• Ability to work remotely from Arizona, Florida, Georgia, or Texas

Preferred Qualifications

• Experience in healthcare quality assurance, medical record auditing, or utilization management
• Bachelor's Degree from an accredited university (BSN preferred)
• Experience with NCQA accreditation standards, HEDIS measures, or Medicare/Marketplace insurance
• CCM or MCG certification
• Bilingual fluency in Spanish
• Proficiency with Google Workspace (Sheets, Docs, Slides, Meets)

Benefits

• Competitive base pay: $83,628 - $109,761.75 per year
• Medical, dental, and vision benefits
• Unlimited vacation program and paid wellness time
• 401(k) plan participation
• Paid holidays, sick time, and parental leave
• Annual performance bonuses

About the Company

Oscar is the first health insurance company built around a full-stack technology platform and a relentless focus on serving members. Founded in 2012, we aim to create a health insurance experience that behaves like a doctor in the family, combining advanced technology with a human touch to improve clinical outcomes.