Nurse Supervisor, Utilization Management Clinical Quality

Hi, we're Oscar. We're hiring a Nurse Supervisor to join our Utilization Management Clinical Quality team.

About the role

The Nurse Supervisor provides day-to-day oversight and management of the team. This role owns daily Nurse team operations, including queue and volume throughput and staffing, and also serves as the primary escalation point for their teams. The Nurse Supervisor supports strategic and clinical initiatives as needed. 

You will report into the Manager, Clinical Programs

Work Location:

If you live within commutable distance to our New York City office (in Hudson Square), our Tempe office (off the 101 at University Dr), or our Los Angeles office (in Marina Del Rey), you will be expected to come into the office at least two days each week. Otherwise, this is a remote / work-from-home role. 

You must reside in one of the following states: Alabama, Arizona, Arkansas, California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, Virginia, Washington, or Washington, D.C. Note, this list of states is subject to change.

Pay Transparency:

The base pay for this role is: $88,800 - $116,550. You are also eligible for employee benefits, participation in Oscar’s unlimited vacation program, and annual performance bonuses.

Responsibilities

• 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 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

Qualifications

• 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)
• 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)
• 3+ years of utilization review experience at a managed care plan or provider organization
• A working knowledge of health insurance/benefit concepts - Medicare and Individual Marketplace insurance experience preferred.

Bonus Points

• Experience in healthcare quality assurance
• 1+ years leading a clinical team at a managed care plan or healthcare organization including in a virtual environment
• Strong understanding of NCQA accreditation standards for utilization management, case management or population health, HEDIS measures and other regulatory requirements
• CCM or MCG certification
• Experience analyzing and interpreting performance and other forms of data
• Proficiency using Google Suite