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Oscar

Award-winning recruitment consultancy; delivering talent across Tech, Digital, Life-Sciences, Energy & Construction

Utilization Review Nurse

Location

Arizona + 16 moreAll locations: Arizona | Florida | Illinois | Iowa | Kansas | Nebraska | New Jersey | North Carolina | Ohio | Oklahoma | Michigan | Missouri | Pennsylvania | South Carolina | Tennessee | Texas | Virginia

Posted

1 day ago

Salary

$35 - $45 / hour

Seniority

Junior

Associate Degree1 yr expEnglish

Job Description

Utilization Review Nurse

Oscar

• 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

Job 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

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