Sr. Quality of Care Review Nurse

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. 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

Clinical Quality programs are designed to enhance clinical outcomes and concierge-level service to our members, through review of services provided to members from network healthcare providers, facilities and Oscar employees. The Senior Clinical Quality Nurse drives clinical performance through the quality auditing and clinical quality of care review process for the departments they serve. The Clinical Quality Nurse serves as a peer mentor and a consultant, working collaboratively with team members to implement audit programs that reflect department goals and key performance indicators, meeting 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. While your daily work will be completed from your home office, 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 and 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 experience auditing medical records and evaluating clinical information and internal documentation to determine the quality of care and service provided to members.

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, HEDIS measures and other regulatory requirements

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

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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.

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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.

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