Senior Clinical Quality Nurse

Job not on LinkedIn

🔥 2 minutes ago

🌵 Arizona, Florida, +14 more states – Remote

🌵 Arizona – Remote 🐊 Florida – Remote 🌽 Illinois – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🌾 Nebraska – Remote 🏖️ New Jersey – Remote 🌲 North Carolina – Remote 🏈 Ohio – Remote 🚗 Michigan – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote 🌴 South Carolina – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⚔️ Virginia – Remote

💵 $75.3k - $98.8k / year

⏰ Full Time

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Oscar Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2012

⚕️ Healthcare Insurance

🏥 Healthcare

💰 $355M Post-IPO Debt - Oscar Health on 2025-09

Healthcare Insurance • Healthcare

Oscar Health is a technology-driven health insurance company that provides individual, family, and small-group health plans in multiple U. S. states. Oscar combines traditional insurance underwriting with digital-first services — a consumer-facing app, 24/7 virtual urgent care, prescription delivery (including $3 meds in many plans), and dedicated Care Teams — and also operates Oscar Primary Care in some markets. The company emphasizes accessible, affordable, high-quality care and uses AI to improve member experience and care delivery. Insurance policies are underwritten by Oscar's state insurance subsidiaries and the company offers both HMO and other plan types across its markets.

📋 Description

• Perform quality audits on clinical documentation for clinicians from a variety of clinical departments • Develop audit surveys and rubrics supporting evidence-based clinical decision making, department workflows, and regulatory accreditation requirements • Pull clinician and provider cases for auditing and track results in department systems • Support organizational readiness and preparation for NCQA and other regulatory audits • Perform delegate oversight audits, write audit result summary reports, and present findings to stakeholders and delegates • Collaborate with leadership to develop corrective action plans addressing identified gaps • Provide 1:1 feedback and coaching to front-line staff and leaders regarding workflows and audit requirements • Develop training tools on quality best practices, audit standards, and related topics • Collaborate with leadership and stakeholders on audit trends, process changes, and training development • Deliver quality-oriented presentations and aggregate quality data to report performance trends • Participate in audit calibration sessions and interrater reliability processes • Comply with applicable laws and regulations • Perform other duties as assigned

🎯 Requirements

• Licensed Registered Nurse with active, unrestricted license in state of residence • Willingness to obtain additional licenses as needed for Oscar’s growth, with Oscar’s support • 2+ years of experience as a Registered Nurse • 2+ years experience working in a clinical care setting • 1+ years of utilization review experience at a managed care plan or provider organization • Must reside in Arizona, Florida, Georgia, Illinois, Iowa, Kansas, Michigan, Missouri, Nebraska, New Jersey, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, or Virginia

🏖️ Benefits

• Employee benefits • Unlimited vacation program • Annual performance bonuses • Medical benefits • Dental benefits • Vision benefits • 11 paid holidays • Paid sick time • Paid parental leave • 401(k) plan participation • Life insurance • Disability insurance • Paid wellness time • Wellness reimbursements