Clinical Review Registered Nurse

2 months ago


Tempe, Arizona, United States Oscar Health Full time
Job Overview

Oscar Health is seeking a dedicated Utilization Review Registered Nurse to enhance our Clinical Review team.

At Oscar, we pride ourselves on being a pioneering health insurance provider, leveraging a comprehensive technology platform to prioritize our members' needs. Our journey began with a vision to create a health insurance experience that resonates with our values—one that embodies the care of a family doctor.

Role Responsibilities

As a Utilization Review Nurse, your primary responsibilities will include:

  • Conducting thorough medical necessity assessments and level of care evaluations for requested services, utilizing clinical judgment alongside Oscar Clinical Guidelines and Milliman Care Guidelines.
  • Gathering essential information through communication with members and healthcare providers to accurately assess clinical conditions and apply evidence-based guidelines.
  • Adhering to established decision-making service level agreements.
  • Facilitating referrals for additional care engagement when necessary.
  • Ensuring compliance with all relevant laws and regulations.
  • Participating in a work schedule that includes one weekend day each week.
  • Performing other related duties as assigned.
Qualifications
  • Possession of an active, unrestricted RN license from the United States or a compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC).
  • Completion of an Associate Degree in Nursing or graduation from an accredited nursing program, or successful completion of a Diploma Program in Practical Nursing from an accredited institution.
  • Capability to obtain additional state licenses as required by business needs.
  • A minimum of 1 year of experience in utilization review within a managed care environment.
  • At least 2 years of clinical experience, including a minimum of 1 year in an acute care setting, such as an emergency room or hospital.
Preferred Qualifications
  • BSN degree.
  • Prior experience conducting concurrent or inpatient reviews for a managed care organization.

At Oscar, we are committed to fostering an inclusive workplace where every individual can thrive. We believe in the power of diverse perspectives and backgrounds to drive innovation in healthcare.

Compensation: The base salary for this position is competitive, and employees are eligible for a comprehensive benefits package, including medical, dental, and vision coverage, paid time off, and retirement plan participation.

Equal Opportunity Employment: Oscar Health is an Equal Opportunity Employer, dedicated to creating a workplace free from discrimination. We welcome applicants from all backgrounds and experiences.



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