Hi, we're Oscar. Were hiring a Complex Case Management Nurse to join our Complex Case Management Team.
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:
As a telephonic & field case management role in which you will educate members on improving health outcomes, assist with transitions from care settings, participate in process improvement & other pilot programs as they arise, & work with the Clinical Concierge Specialist & other Oscar teams to ensure exceptional care for our members
You will report to a Complex Case Management Lead.
- Assist in the coordination of care across a variety of settings (ER, inpatient, post acute, outpatient, home care) while maintaining strict confidentiality & the highest level of professionalism
- Actively reach out to members undergoing difficult health challenges & help guide them through the healthcare system to improve their overall experience
- Complete a comprehensive biopsychosocial needs assessment to help identify member needs
- Develop an outcome-based plan of care, based on the members input & assessed clinical & social needs with anticipated targeted dates for accomplishment
- Conduct in-home & facility visits to engage & educate the member (and their family/caregivers)
- Attend doctor appointments with members & collaborate with their providers to assist them in better understanding their plan of care
- Proactively reach out to hospital case managers to assist with safe discharge planning to appropriate level of care or home
- Seek guidance from medical directors to advocate for members to get the appropriate care they need.
- Act as a member advocate & assist with problem solving, as well as addressing any barriers to care or compliance with the care plan
- Educate other teams on the CCM program & collaborate to identify high risk members who would be appropriate
- Work with non-clinical teammates in assisting members to navigate the healthcare system, including coaching non-clinicians on how they can add value to all member interactions
- Communicate with members via phone, secure messaging, & in person to provide education on health conditions, new medications, & procedures
- Participate in surveys, studies, & special projects as assigned
- 2+ years of clinical experience
- Active, unrestricted Nursing license (RN) in your state of hire & ability to obtain additional licensure as needed.
- Working knowledge of Milliman Care Guidelines
- Case Management experience
- Previous work from home & proven comfort with accessing systems remotely
- Bilingual in Spanish or Creole
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.