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Utilization Review Nurse
O
Utilization Review Nurse
Oscar Health•United States
Full-timeRemote
Company
Oscar Health
Location
United States
Type
full-time
Work Schedule
full time
Work Location
remote
Oscar Health•United States
Full-timeRemote
Company
Oscar Health
Location
United States
Type
full-time
Work Schedule
full time
Work Location
remote
Job Description
Oscar Health seeks a Utilization Review Nurse to evaluate medical necessity for member care plans. Leverage your clinical expertise in a tech-forward healthcare environment. Drive efficient, high-quality utilization decisions remotely across the US. (214 characters)
Full Description
Oscar Health pioneers tech-enabled health insurance. This Utilization Review Nurse role assesses clinical appropriateness of care requests.
Review inpatient and outpatient cases daily using InterQual criteria. Conduct peer-to-peer discussions with providers to resolve denials. Analyze utilization trends to optimize member outcomes and cost efficiency. Collaborate with care teams on complex prior authorizations.
Hold active RN license. Possess 3+ years in utilization review or case management. Proficiency in MCG/InterQual guidelines essential. Experience with EHR systems required. URAC certification preferred.
Excel in clinical decision-making. Master data analysis tools. Demonstrate strong communication.
Dynamic, innovative culture.
Competitive compensation.
Key Skills
InterQual criteriaUtilization reviewClinical assessmentPeer-to-peer negotiationEHR proficiency