Operating on the belief that healthcare is broken, Oscar Health Insurance is on a mission to reinvent and humanize the industry by combining technology, design,
Sr. Quality of Care Review Nurse
Location
United States
Posted
3 days ago
Salary
$83.6K - $109.8K / year
Seniority
Senior
No structured requirement data.
Job Description
Sr. Quality of Care Review Nurse
Oscar Health Insurance
Role Description Hi, we're Oscar. We're hiring a Sr. Quality of Care Review Nurse to join our Quality team. Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. About the role: - Clinical Quality programs are designed to enhance clinical outcomes and concierge-level service to our members. - The Senior Clinical Quality Nurse drives clinical performance through the quality auditing and clinical quality of care review process. - Serves as a peer mentor and consultant, working collaboratively with team members to implement audit programs that reflect department goals and key performance indicators. - Meets all regulatory and organizational requirements. You will report into the Nurse Manager, Quality of Care. Work Location: - This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; or Texas. - Occasional travel may be required for team meetings and company events. Pay Transparency: - The base pay for this role is: $83,628 - $109,761.75 per year. - You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses. Responsibilities - Perform quality audits of internal and external member, provider and delegated vendor interactions. - Guide interrater reliability (IRR) assessments, supporting evidence-based clinical decision-making and workflow adherence. - Investigate provider and facility quality of care concerns, identifying and escalating negative performance trends for corrective action. - Consult with company partners to ensure that programs developed meet changing organizational needs while following accreditation and regulatory requirements. - Present quality and performance trend data to organizational partners, delegates and quality subcommittees as applicable. - Collaborate on corrective action plans to address identified gaps. - Compliance with all applicable laws and regulations. - Other responsibilities as assigned. Requirements - Licensed Registered Nurse with active, unrestricted license in state of residence. - Willingness to obtain additional licenses as needed for Oscar's growth (with Oscar's support). - 2+ years of experience as a Registered Nurse. - 2+ years experience working in a clinical care setting. Bonus Points - Health plan utilization management experience or case management experience. - Experience in healthcare quality assurance, including auditing medical records and evaluating clinical information. - Experience in health plan case management. - Bilingual - fluent in Spanish to audit Spanish-language verbal and written interactions. - Bachelor's Degree from an accredited university, BSN Preferred. - A working knowledge of health insurance/benefit concepts - Medicare and Individual Marketplace insurance experience a plus. - Experience with NCQA accreditation standards for utilization management, case management or population health. - CCM or MCG certification. - Experience analyzing performance and other forms of data. - Proficiency using Google applications like Sheets, Docs, Slides and Meets. - Comfortable using Google Meets and other platforms to communicate with internal/external partners. Benefits - Medical, dental, and vision benefits. - 11 paid holidays. - Paid sick time. - Paid parental leave. - 401(k) plan participation. - Life and disability insurance. - Paid wellness time and reimbursements.
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