Oscar Health · 1 month ago
Utilization Review Nurse
United States
Full-time
Remote
Entry Level
$35/hr - $45.94/hr
1+ years expOscar is a health insurance company focused on serving its members through a technology platform. The Utilization Review Nurse will perform case reviews, evaluate medical records, and make recommendations on treatment appropriateness.
Health CareHealth InsuranceInsuranceInsurTech
Responsibilities
Complete medical necessity reviews and level of care reviews for requested services using clinical judgment and Oscar Clinical Guidelines, Milliman Care Guidelines
Obtain the 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
Qualification
Required
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 or Bachelors Degree - Nursing or Graduate of Accredited School of Nursing
MCG or InterQual tooling experience
Ability to obtain additional state licenses to meet business needs
1+ year of utilization review experience in a managed care setting
1+ years of clinical experience (including at least 1+ year clinical practice in an acute care setting, i.e., ER or hospital)
Preferred
BSN
Previous experience conducting concurrent or inpatient reviews for a managed care plan
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
Company
Oscar Health
Oscar is a health insurance company that offers individual and family plans, medicare advantages, and small group products.
1001-5000 employees
H1B Sponsorship
Oscar Health has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (19)
2024 (24)
2023 (22)
2022 (36)
2021 (13)
Funding
Current Stage
Public CompanyTotal Funding
$1.99BKey Investors
Tiger Global ManagementAlphabetFounders Fund
2025-09-16Post Ipo Debt· $355M
2021-03-03IPO
2020-12-17Private Equity· $140M
Leadership Team
Mark Bertolini
Chief Executive Officer
Steven B. Kelmar
Executive Vice President & COS
Recent News
2026-01-17
2026-01-16
2026-01-16
Company data provided by crunchbase