Hi, we're Oscar. We're hiring a Nurse Manager to join our Clinical Quality team.

Oscar is the first health insurance company built around a full stack technology platform & a focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselvesone that behaves like a doctor in the family.

About the role

You will play a key role in driving clinical & operational performance within their department by ensuring all department activities are carried out in a clinically appropriate manner observing organizational processes & evidence-based resources. You will work with direct reports, providers, external & internal stakeholders to review clinical services provided to Oscar members for clinical appropriateness & adherence to organizational & regulatory requirements. You will partner with key contacts across the organization, communicating results & recommendations for improvement across disciplines. The Nurse Manager grows clinical teams through the direct leadership of leaders & staff, playing a key role in driving the achievement of department quality & productivity metrics, goals & KPIs. You will use subject matter expertise & clinical knowledge to address escalated issues.

You will report to the Director, Quality Monitoring & Improvement.

Work Location: 

Oscar is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture & our mission. 

If you live within commutable distance to our New York City office (in Hudson Square), our Tempe office (off the 101 at University Dr), or our Los Angeles office (in Marina Del Rey), you will be expected to come into the office at least two days each week. Otherwise, this is a remote / work-from-home role. 

You must reside in one of the following states: Alabama, Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, Virginia, Washington, or Washington, D.C. Note, this list of states is subject to change. #LI-Remote

Pay Transparency:

The base pay for this role is: $108,000 - $141,750 per year. You are also eligible for employee benefits, participation in Oscars unlimited vacation program & annual performance bonuses

Responsibilities

• Provide input in creating & maintaining, based on regulatory, accreditation, & organizational requirements,  policies & procedures defining the completion of all department functions to help ensure they meet the needs of our members, providers & internal/external stakeholders. 
• Oversee daily operations to ensure team work assignments are completed within established turnaround times & in accordance with department policies & procedures, regulatory & accreditation requirements.
• Monitor team dashboards, review & analysis of productivity reporting, completion of quality audits & other data to monitor individual & team performance.
• Maintain expertise on department tools & platforms to inform analysis.
• Analyze data to identify performance trends/opportunities for improvement & work  with data analytics to ensure productivity & quality data provides actionable insights on team/individual performance against goals.
• Create corrective action plans or performance improvement plans to address identified opportunities.
• Drive a culture of accountability & recognition that aligns with department objectives & increases employee engagement. 
• Provide coaching, development & performance management to staff & leaders, evaluating performance against goals throughout the year.
• Compliance with all applicable laws & regulations
• Other duties as assigned

Qualifications

• Bachelor of Science in Nursing
• Active, unrestricted Nursing license (RN) in the state of hire & ability to obtain additional licensure 
• 4+ years of experience in a healthcare setting as a nurse 
• Strong computer literacy, able to work effectively in multiple platforms
• 2+ years leading a clinical team at a managed care plan or healthcare organization including in a virtual environment

Bonus Points

• Experience performing quality of care investigations or quality auditing or compliance oversight for a healthcare organization.
• Proficiency using case ticketing systems e.g. Jira or Appian to prioritize & document team activities.
• 1+ years leading and/or implementing process improvement initiatives/Six Sigma or large scale projects
• 1+ years of experience working in production/operations including case prioritization/case triage 
• Proficiency in creating & working with Google Sheets, Slides, Docs & using applications to create presentations to stakeholders, & senior leadership.
• Experience communicating with senior leadership in a live (virtually or in-person) setting or through email
• Experience leading employees & presenting to large groups in a virtual environment.
• Working knowledge of NCQA & state/federal regulatory requirements for the areas served by the team
• Working knowledge of utilization management clinical decision-making criteria (milliman care guidelines)