Utilization Review Nurse

📋 Description

• Complete medical necessity and level-of-care reviews per Oscar guidelines.
• Gather records by phone/fax to assess clinical condition and apply 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.

🎯 Requirements

• Active, unrestricted RN license in the US or compact multistate RN license per NLC.
• Associate or Bachelor's degree in Nursing.
• MCG or InterQual tooling experience.
• Ability to obtain additional state licenses to meet business needs.
• 1+ year of utilization review experience in managed care.
• 1+ year clinical experience in acute care (ER or hospital).

🎁 Benefits

• Remote work from home.
• Comprehensive benefits: medical, dental, and vision.
• 11 paid holidays.
• Paid sick time.
• Paid parental leave.
• 401(k) plan with employer contributions.