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.

• 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

Role Description Director I, functionally known as the Associate Director of Suicide Prevention Policy and Services (SPPS), will report directly to the Deputy Associate Commissioner (Director III) of the Prevention and Behavioral Health Promotion Team (PBHP DAC) in the Substance Use Programs (SUP) Unit of Behavioral Health Services (BHS). - Performs advanced (senior level) managerial work, providing direction and guidance in strategic operations and program planning with a focus on suicide prevention. - Establishes goals and objectives for the suicide prevention team that align with PBHP, SUP, and BHS goals and strategies for operations. - Serves on the PBHP leadership team in an Associate Director capacity, assisting in the strategic development and growth of PBHP. - Represents PBHP in internal and external meetings, work groups, trainings, and/or events. - Establishes the strategic plan, goals, and objectives specific to suicide prevention. - Provides leadership to the Statewide Behavioral Health Coordinating Council’s (SBHCC) Suicide Prevention Subcommittee. - Develops policies, procedures, and guidelines. - Establishes priorities, standards, and measurement tools for determining progress in meeting suicide prevention goals. - Coordinates and evaluates program activities or business functions. - Reviews and approves budgets within departments or divisions to ensure effective resource allocation. - Supervises staff who design, implement, and oversee suicide prevention, intervention, and postvention programs, training, and technical assistance. - Uses data to make data-informed decisions about the need for new suicide prevention initiatives targeting specific communities in Texas. - Works under minimal supervision, with extensive latitude for the use of initiative and independent judgment. Qualifications - A minimum of a master’s degree in prevention science, public health, social work, health education, business administration, health services, or other related field from an accredited college or university. - A minimum of two years of supervisory or managerial experience. - Experience leading cross-functional teams in a public health or behavioral health field is preferred. - A minimum of five years of project or grants management experience is required; with at least three of those years managing prevention, behavioral health, or public health programs required. - At least two years of prior government (local, state, federal, university, etc.) experience is highly preferred. Requirements - Knowledge of best practices for suicide prevention in behavioral health services, including evidence-based programs, interventions, and treatments. - Skills in strategic planning and thinking big picture to establish a clear vision and direction for suicide prevention. - Ability to communicate effectively orally and in writing. - Demonstrate strong organizational skills and prioritize workload. - Work independently with minimal supervision and make sound decisions. Benefits - 100% paid employee health insurance for full-time eligible employees. - A defined benefit pension plan. - Generous time off benefits. - Numerous opportunities for career advancement.