Oscar Health pioneers affordable, tech-driven health insurance nationwide, and this Utilization Review Nurse position anchors our commitment to precise, equitable care decisions. The role centers on scrutinizing inpatient and outpatient requests against evidence-based criteria, authorizing appropriate interventions while flagging overutilization. Daily, review physician orders via Oscar's proprietary platform, collaborate with care teams on complex cases like elective surgeries or extended rehab stays, and document decisions in real-time for compliance audits. Participate in peer reviews and contribute to quarterly guideline updates, directly influencing member satisfaction and cost efficiency. Candidates must hold an active RN license, possess 3+ years in utilization management or case review, and demonstrate proficiency with InterQual or MCG criteria. A BSN preferred; prior managed care experience in payer settings is essential. Familiarity with HIPAA regulations and electronic health records rounds out core needs. Excel with sharp analytical thinking, precise communication across multidisciplinary teams, and adeptness at EHR systems alongside clinical judgment. Thrive amid collaborative innovators prioritizing member-centric solutions in a flexible workspace. Market-rate compensation pairs with comprehensive health coverage, generous PTO, and wellness stipends.