Utilization Review Registered Nurse - Remote

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

Oscar is the first health insurance company built around a full stack technology platform and a 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.

About the role

As the Utilization Nurse you will perform frequent case reviews, check medical records and speak with care providers regarding treatment. You will 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 remote / work-from-home 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. #LI-Remote

The base pay for this role is: $72,800 - $95,555 per year. You are also eligible for employee benefits, monthly vacation accrual at a rate of 10 days per year.

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 Service level agreements
• 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 …