Utilization Review Nurse

Responsibilities

• Complete medical necessity and level of care reviews for requested services using clinical judgment and evidence-based guidelines
• Utilize Oscar Clinical Guidelines and Milliman Care Guidelines (MCG) to assess care appropriateness
• Obtain necessary clinical information via telephone and fax to assess member conditions
• Meet required decision-making SLAs and ensure compliance with all applicable laws and regulations
• Refer members for further care engagement when necessary

Requirements

• Active, unrestricted US RN licensure or an active compact multistate license
• Associate Degree in Nursing or graduate of an accredited school of nursing/nursing diploma program
• 1+ years of utilization review experience in a managed care setting
• Strong experience utilizing Milliman Care Guidelines (MCG)
• 1+ years of clinical experience, including at least one year in an acute care setting (e.g., ER or hospital)
• Ability to obtain additional state licenses to meet business needs

Preferred Qualifications

• Bachelor of Science in Nursing (BSN)
• Previous experience conducting concurrent or inpatient reviews for a managed care plan

Benefits

• Competitive hourly pay ranging from $35.00 - $45.94
• Medical, dental, and vision benefits
• 11 paid holidays, paid sick time, and paid parental leave
• 401(k) plan participation
• Life and disability insurance
• Paid wellness time and reimbursements
• 15 days of vacation accrual per year

About the Company

Oscar is on a mission to change healthcare by creating an experience made whole by unique backgrounds and perspectives. We cultivate an environment where people can be their most authentic selves and find both belonging and support.