Supervisor, Utilization Review Nurse – Vendor Management
Oscar
full-time
Posted on:
Location Type: Remote
Location: Arizona • Florida • United States
Visit company websiteExplore more
Salary
💰 $91,980 - $120,629 per year
About the role
- Own daily workforce management, including staffing and queue assignments, PTO/leave, and payroll/compensation.
- Manage queue on a daily basis, ensuring compliance with regulatory timelines, staff coverage, and coordination with internal teams for forecasting and timely handling of ad hoc escalations
- Ensure on-shore team adheres to department policies and workflows and serve as continual champion of the Oscar mission.
- Drive and own the success of clinical auditing and performance through ongoing evaluations; effectively use Oscar tools to monitor and trend nurse productivity and auditing data for assessment and reporting.
- Support the onboarding and training of newly-hired clinicians and partner with the Clinical Quality & Training team on the development and maintenance of clinical training and resource material.
- Partner with the Talent Acquisition team on clinical hiring initiatives.
- Complete medical necessity and level of care reviews using clinical judgment and the Plan's designated clinical guidelines, if applicable.
- Comply with department performance and quality metrics, and adhere to training and remediation requirements.
- Compliance with all applicable laws and regulations
- Other duties as assigned
Requirements
- 3+ years of utilization review experience at a managed care plan or provider organization
- Active, unrestricted Registered Nurse (RN) licensure from the United States and in the state of hire, OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC)
- 2 + years of off-shore managing vendor experience
- 2+ year of leadership experience
- Associate Degree and/or Bachelors of Nursing from an accredited school of nursing
- 5+ years healthcare experience (including at least 2 years clinical practice in an acute care setting)
- Milliman (MCG) experience
Benefits
- Employee benefits
- Participation in Oscar's unlimited vacation program
- Annual performance bonuses
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
utilization reviewclinical auditingnurse productivity monitoringmedical necessity reviewslevel of care reviewsclinical judgmentstaffing managementqueue managementperformance metrics compliancetraining and onboarding
Soft Skills
leadershipcommunicationteam coordinationorganizational skillsproblem-solvingtraining developmentcollaborationadaptabilityattention to detailchampioning mission
Certifications
Registered Nurse (RN) licensurecompact multistate RN license