💼 About This Role

You'll perform medical necessity reviews and level of care reviews for Oscar Health members. Your clinical judgment ensures appropriate care based on evidence-based guidelines. This remote role offers the chance to impact patient outcomes while working with a mission-driven health tech company.

🎯 What You'll Do

• Complete medical necessity and level of care reviews using clinical guidelines
• Obtain information to assess member's clinical condition and apply guidelines
• Meet decision-making SLAs and refer members for further care engagement
• Comply with all applicable laws and regulations

📋 Requirements

• Active, unrestricted RN licensure in US state or compact multistate license
• Associate Degree in Nursing or graduate of accredited school of nursing
• 1+ year utilization review experience in managed care setting
• 1+ years clinical experience including acute care (ER or hospital)

✨ Nice to Have

• BSN degree
• Experience with concurrent or inpatient reviews for managed care plan

🎁 Benefits & Perks

• 🏥 Medical, dental, and vision benefits
• 🏖️ 15 vacation days per year (monthly accrual)
• 🎉 11 paid holidays and paid sick time
• 👶 Paid parental leave
• 💰 401(k) plan with life and disability insurance

📨 Hiring Process

Estimated timeline: 2-3 weeks · AI estimate

1. 1Recruiter Screen· 30 min
2. 2Hiring Manager Interview· 45 min
3. 3Panel Interview· 60 min