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

🦅 H1B Visa Sponsor

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Oscar

WebsiteLinkedInAll Job Openings

51 - 200 employees

💼 Consulting

🏗️ Construction

🏥 Healthcare

💰 $140M Private Equity Round on 2020-12

Consulting • Construction • Healthcare

Oscar is a world-class specialist STEM recruitment agency that provides industry-leading talent solutions. The company operates across six brands, connecting top talent with companies in various sectors including technology, construction, life sciences, and renewable energy. With offices across the globe, Oscar is recognized as a top-five company to work for and is committed to delivering excellence in staffing services.

📋 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