Hi, we're Oscar. Were hiring a Complex Case Management Nurse to join our Clinical team in our New York office.
Oscar is a technology-driven, consumer-focused health insurance startup founded in 2012 & headquartered in New York City. Our goal is to make health insurance simple, transparent, & human. We need your help to do so.
About this role:
The Complex Case Management Program's goal is to improve quality outcomes for our members & improve service use & cost. You will work in the Clinical Care Delivery department providing onsite & telephonic care management services to individuals identified as high risk members. You will be the primary contact for a selected group of members & their families.
You will report into the Medical Director for Complex Case Management.
- Develop an outcome-based plan of care, based on the members input & assessed member clinical & social needs with anticipated targeted dates for accomplishment.
- Evaluate expected outcomes & associated costs of the plan of care & any proposed alternative plan of care & makes necessary revisions.
- Initiate onsite hospital visits/rounds as needed to assess patient progress & meet with appropriate members of the patient care team.
- Conduct initial in-home or facility visit to engage & educate the member (and their family/caregivers) to the Complex Case Management program.
- Conduct telephonic, in-home, or in-facility visits to monitor the members adherence to their established care plans.
- Coordinate all care & services provided to ensure that quality care is delivered in the most appropriate setting.
- Manage transition of care ensuring that the Plan of Care moves with the member & updates/modifies the care plan as the members health care status changes.
- Identify & address psychosocial needs of the members & family & facilitates consultations with Social Worker.
- Identify & address pharmacological & DME needs of the members & facilitates consultations with the pharmacy department.
- Coordinate post-discharge clinic appointments, medication reconciliation, PCP & specialist visits
- Active, unrestricted RN (BSN preferred) in the state of residency
- Willingness to obtain additional state licenses as needed for Oscar's growth (with Oscar's support)
- Two years of case management experience at a managed care plan or provider organization and
- Ability to work effectively both on an individual basis & as part of a multidisciplinary team
- Strong computer skills to maintain accurate & complete documentation in our Case Management record systems
- Working knowledge of Milliman Care Guidelines
Life at Oscar:
At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves & find both belonging & support. We're on a mission to change health care -- an experience made whole by our unique backgrounds & perspectives.
We encourage our members to care for their whole selves, & we encourage our employees to do the same with comprehensive medical benefits, generous paid-time off, paid parental leave, retirement plans, company social events, stocked kitchens, wellness programs, & volunteer opportunities.
Oscar applicants are considered solely based on their qualifications, without regard to applicants disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (firstname.lastname@example.org) to make the need for an accommodation known.
Pay Transparency Policy
Oscar ensures that you won't be discharged or discriminated against based on whether you've inquired about, discussed, or disclosed your pay. Read the full policy here.