Hi, we’re Oscar. We’re hiring an Associate Director, Utilization Review to join our Clinical Review 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

You will oversee and drive clinical operations and process, supporting managers and supervisors, responsible for the team’s output and strategy (such as budget, staffing, organization direction, etc.), and maintains oversight into the end-to-end utilization review process (includes appeals) abiding by department compliance at the state level as well as with NCQA and CMS.

You will report into the VP Medical Director, CM and UM.

This is a remote / work-from-home role. You must reside in one of the following states: Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Iowa, Maryland, Massachusetts, Michigan, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, Tennessee, Texas, Utah, Virginia, Washington, or Washington, D.C. Note, this list of states is subject to change. #LI-Remote

The base pay for this role is: $152,000 - $199,500 per year. You are also eligible for employee benefits, participation in Oscar’s unlimited vacation program, and annual performance bonuses.

Responsibilities

• Manage, and implement clinical strategic initiatives to avoid high cost utilization while ensuring clinical operations meet our needs and align with the company’s mission/values
• Build relationships with the cross-functional company partners by collaborating on process improvement initiatives and overseeing provider facing relationships
• Strategize with and make recommendations to senior leadership on staffing, budget, clinical operational support, optimization, efficiency, & organizational culture, drive process improvement and performance improvement, and ensure feedback is collected from the nursing team and relayed to leadership
• Collaborate with Clinical & Business Operations to improve efficiency and reduce admin costs
• Manage staffing budget and projections
• Develop the nursing team leaders driving team and individual success
• Understand and support applicable regulatory and accreditation requirements and supporting the team’s quality auditing
• Maintain continued professional growth and education to meet continuing education requirements and demonstrate knowledge & understanding of current nursing care practice

Qualifications

• Active, unrestricted 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)
• Ability to obtain additional state licenses for Oscar’s growth (with Oscar’s support)
• 5+ years utilization review experience at a managed care plan or provider organization and /or healthcare experience (including at least three years in clinical practice in an acute care setting)
• 5+ years of managerial experience

Bonus Points

• BSN or MS of Nursing
• Commercial and Medicare Advantage expertise
• Willing and able to learn new software tools