Care Management RN
1 week ago
Oscar Health is seeking a dedicated Utilization Review Registered Nurse to enhance our Clinical Review team.
As a pioneering health insurance provider, Oscar Health integrates a comprehensive technology platform with a commitment to member service. Our journey began with a vision to redefine health insurance into a model that prioritizes patient care.
Role ResponsibilitiesIn this position, you will:
- Conduct thorough medical necessity evaluations and care level assessments for requested services, utilizing clinical expertise and Oscar's Clinical Guidelines.
- Gather essential information through communication with healthcare providers to assess a member's clinical status and apply evidence-based protocols.
- Adhere to established decision-making service level agreements.
- Facilitate referrals for additional care when necessary.
- Ensure compliance with all relevant laws and regulations.
- Maintain a work schedule that includes one weekend day each week.
- Perform other assigned duties as required.
The ideal candidate will possess:
- A valid, unrestricted RN license from the United States or a compact multistate RN license as defined by the Nurse Licensure Compact (NLC).
- 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.
- The ability 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.
- A Bachelor of Science in Nursing (BSN).
- Prior experience conducting concurrent or inpatient reviews for a managed care organization.
At Oscar Health, we are committed to fostering an inclusive workplace where every individual can thrive. We are dedicated to transforming healthcare through our diverse perspectives and backgrounds.
Compensation Transparency: The base salary for this role is competitive and is complemented by a comprehensive benefits package, including medical, dental, and vision coverage, paid time off, and a 401(k) plan.
Reasonable Accommodations: Oscar Health is an equal opportunity employer and welcomes applicants from all backgrounds. We are committed to providing reasonable accommodations during the application process for those who require them.
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