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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
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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