Utilization Review Nurse

Job not on LinkedIn

🕒 June 24

🌵 Arizona, Florida, +15 more states – Remote

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

💵 $35 - $45 / hour

⏰ Full Time

🟢 Junior

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Oscar Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2012

⚕️ Healthcare Insurance

🏥 Healthcare

🔥 Funding within the last year

💰 $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 frequent case reviews and check medical records • Speak with care providers regarding treatment as needed • Make recommendations regarding appropriateness of care for identified diagnoses based on research results • Report into the Supervisor, Utilization Review • Complete medical necessity reviews and level of care reviews for requested services using clinical judgment and Oscar Clinical Guidelines, Milliman Care Guidelines • Obtain information necessary (via telephone and fax) to assess a member's clinical condition, and apply the appropriate evidence-based guidelines • Meet required decision-making SLAs • Refer members for further care engagement when needed • Compliance with all applicable laws and regulations • Other duties as assigned

🎯 Requirements

• Active, unrestricted RN licensure from the United States in [state] OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC) • Associate Degree - Nursing or Graduate of Accredited School of Nursing Or Successful completion of Diploma Program in Practical Nursing of Accredited School of Nursing • Ability to obtain additional state licenses to meet business needs • 1+ year of utilization review experience in a managed care setting • Strong experience utilizating MCG (Milliman Care Gudielines) • 1+ years of clinical experience (including at least 1+ year clinical practice in an acute care setting, i.e., ER or hospital)

🏖️ Benefits

• Employee benefits • Monthly vacation accrual at a rate of 15 days per year