Hi, we're Oscar. Were hiring a Utilization/Clinical Review Nurse - Medicare Advantage to join our Clinical team in our Tempe 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 the role:
We're looking for experienced clinicians to join the fast-growing Utilization Management/Clinical Review team . We're working to bring a new level of service to utilization review & ensure Oscar members receive access to appropriate care in a timely, transparent way.
As a Utilization/Clinical Review Nurse, you will determine the medical appropriateness of inpatient & outpatient services by reviewing clinical information & applying evidence-based guidelines. You will also interact with Oscar providers, members, & internal service team to obtain necessary information & communicate approval determinations.
You will report into the Senior Manager of Nursing
- Collect relevant medical information (via telephone & fax) & apply the appropriate evidence-based guidelines & medical policy
- Meet required decision-making timeframes, including promptly triggering escalation for cases requiring physician review
- Clearly document all communication & decision-making within our utilization review tracking platform, ensuring a peer could easily reference & understand your decision
- Develop a working familiarity with applicable regulatory & accreditation requirements
- Maintain continued professional growth & education to meet continuing education requirements & demonstrate knowledge & understanding of current nursing care practice
- Active, unrestricted RN or LVN (BSN preferred) license & willingness to obtain additional state licenses as needed for Oscar's growth (with Oscar's support)
- Two (2) years utilization review experience at a managed care plan or provider organization and
- Five years healthcare experience (including at least 2 years clinical practice in an acute care setting, i.e., ER or hospital)
- Experience with Medicare or Medicaid Utilization Review
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 aim to make health care affordable & accessible for all, & apply this same vision to our perks & benefits, including: medical benefits, unlimited 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 (email@example.com) 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.