Hi, we're Oscar. We're hiring a Utilization Review Nurse, BPO Supervisor to join our team. Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family. About the role: You will provide daily oversight and management of the team. You will own the daily Nurse off-shore team operations, including queue and volume throughput and staffing, and also serves as the primary escalation point for their teams. You will supports strategic and clinical initiatives. You will report into the Manager, Utilization Review. Work Location:This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois; Iowa; Kansas; Michigan; Missouri; Nebraska; New Jersey; North Carolina; Ohio; Oklahoma; Pennsylvania; South Carolina; Tennessee; Texas; or Virginia. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events.#LI-Remote Pay Transparency: The base pay for this role is: $91,980 - $120,629 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program, and annual performance bonuses. Responsibilities: - Own daily workforce management, including staffing and queue assignments, PTO/leave, and payroll/compensation. - Manage queue on a daily basis, ensuring compliance with regulatory timelines, staff coverage, and coordination with internal teams for forecasting and timely handling of ad hoc escalations - Ensure on-shore team adheres to department policies and workflows and serve as continual champion of the Oscar mission. - Drive and own the success of clinical auditing and performance through ongoing evaluations; effectively use Oscar tools to monitor and trend nurse productivity and auditing data for assessment and reporting. - Support the onboarding and training of newly-hired clinicians and partner with the Clinical Quality & Training team on the development and maintenance of clinical training and resource material. - Partner with the Talent Acquisition team on clinical hiring initiatives. - Complete medical necessity and level of care reviews using clinical judgment and the Plan's designated clinical guidelines, if applicable. - Comply with department performance and quality metrics, and adhere to training and remediation requirements. - Compliance with all applicable laws and regulations - Other duties as assigned Requirements: - 3+ years of utilization review experience at a managed care plan or provider organization - Active, unrestricted Registered Nurse (RN) licensure from the United States and in the state of hire, OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC) - 2 + years of off-shore managing vendor experience - 2+ year of leadership experience - Associate Degree and/or Bachelors of Nursing from an accredited school of nursing - 5+ years healthcare experience (including at least 2 years clinical practice in an acute care setting) - Milliman (MCG) experience Bonus points: - Bachelors of Nursing (BSN) degree - Masters of Science in Nursing (MSN) degree, or MBA/Healthcare administration degree - Project management certification (e.g. Six Sigma, SCRUM, Agile) This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here. At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives. Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements. Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts. Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant’s disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known. California Residents: For information about our collection, use, and disclosure of applicants’ personal information as well as applicants’ rights over their personal information, please see our Privacy Policy.

Role Description Under the guidance of the SIU Management, this position is responsible for the accurate and thorough clinical investigation of potential fraud, waste and abuse (FWA) for all lines of business. The scope of accountability includes investigating and remediating allegations of FWA while adhering to compliance and regulatory requirements. Primary activities include: - Substantiating referrals - Case planning and research - Conducting onsite or desk audits - Clinical reviews of medical records to ensure correct billing of services and appropriateness of care - Interviewing potential witnesses - Developing corrective action plans - Developing correspondence to impacted parties - Managing disputes - Collaborating with law enforcement and regulatory agencies Qualifications - Must meet the NYS DFS’s and the NYS OMIG’s minimum investigator requirements - A minimum of five years in the healthcare field working in FWA investigations and audits; or five years of insurance claims investigation experience or professional investigation experience with law enforcement agencies; or seven years of professional investigation experience involving economic or insurance related matters; or an associate’s or bachelor’s degree in criminal justice or related field; or employment as an investigator in the SIU on or before December 28, 2022 - Current NYS R.N. license with a minimum of three years clinical experience; medical/surgical background preferred - Current CPC designation or must obtain CPC designation within one year of hire date - Knowledge of medical record coding conventions (e.g. CPT, DRG, HCPCS, ICD10, etc.) - A general understanding of contract benefits, electronic data processing systems, and organizational policies and procedures - Demonstrates excellent oral communication skills and proficient writing skills for the creation of comprehensive professional documents - Demonstrates proficient computer skills in Word, Excel, Internet, and email - Ability to multi-task and balance priorities - Excellent interpersonal skills Requirements - Performs more complex investigations with less direct supervision - Offers process improvement suggestions and participates in the solution of more complex issues/activities - Provides and supports training or reference materials for internal team members as appropriate - Consistently provides accurate, organized and well written audit results with minimal assistance from management - Oversees and coordinates the daily activities of the non-clinical SIU staff medical record reviews - Keeps abreast of new developments in the field of medical technology through medical literature research, participation in seminars, monitoring professional society websites, etc. - Mentors new/junior staff and assists with coaching, whenever necessary - Participates on committees Benefits - Participation in group health and/or dental insurance - Retirement plan - Wellness program - Paid time away from work - Paid holidays Company Description In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position. Equal Opportunity Employer Compensation Range(s): - Level I (E2): Minimum: $62,400 - Maximum: $96,081 - Level II (E4): Minimum: $65,346 - Maximum: $106,929 Please note: There may be opportunity for remote work within all jobs posted by the Excellus Talent Acquisition team. This decision is made on a case-by-case basis. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

• Perform expert clinical review of inpatient medical records, assessing medical necessity based on national guidelines, CMS regulations, Humana policies, and recognized clinical standards • Analyze complex hospital-based cases and deliver clear, well-reasoned utilization management determinations • Communicate with external providers via phone to obtain clinical information and discuss review outcomes • Collaborate within a structured, team-oriented environment that emphasizes integrity, professionalism, and collegiality • Conduct inpatient medical necessity reviews promptly and in accordance with regulatory requirements • Uphold excellence in productivity, accuracy, quality, and timely completion of assigned tasks • Communicate review outcomes clearly and professionally in both verbal and written formats • Demonstrate flexibility and adaptability to changing workflows, tools, and utilization management procedures

• Provides clear medical leadership in the Study team • Creates clinical trial protocols while implementing the latest scientific information • Contributes to site selection • Reviews and approves study protocols and amendments, Clinical Study Reports (CSRs), Informed Consent Forms (ICFs), Case Report Forms (CRFs), protocol deviation decisions and other clinical documents as required for clinical trials • Real time Medical Monitoring of clinical studies • Ensures early identification of medical issues • Interprets clinical trial data for regulatory documents • Acts as the medical point of contact for all internal and external stakeholders • Ensures study compliance for all medical aspects