Full-Time

Utilization Review Nurse

Confirmed live in the last 24 hours

Sidecar Health

Sidecar Health

201-500 employees

Affordable health insurance with price transparency

Compensation Overview

$80k - $95k/yr

+ Bonus Opportunity + Equity Package

Senior

Florida, USA + 3 more

More locations: Georgia, USA | Kentucky, USA | Ohio, USA

Must reside in Florida, Georgia, Kentucky, or Ohio for consideration.

Category
Nursing & Allied Health Professionals
Medical, Clinical & Veterinary
Connection
Connection
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Requirements
  • Clinical credentials (RN)
  • 5+ years of experience as a nurse providing direct patient care, preferably in a hospital setting
  • 3+ years of utilization review experience, preferably in a health plan, managed care, or third-party administrator environment
  • Hands-on experience using Milliman Care Guidelines (MCG)
  • Medical billing and/or coding experience — this can be in a provider setting (billing, revenue cycle management, clinical auditing, legal compliance nurse) or payor setting (utilization management, prior auth review, payment integrity, etc.)
  • Excellent written communication skills with experience drafting member, patient, and provider-facing letters
  • Ability to think critically and make decisions with limited information
  • Exceptional cross-functional collaboration skills with the ability to make recommendations to leadership
  • Ability to problem solve and handle escalated cases
Responsibilities
  • Utilize Milliman Care Guidelines (MCG) to evaluate the medical necessity and appropriateness of proposed and ongoing treatments for our members
  • Participate in quality improvement initiatives to enhance the efficiency and effectiveness of the clinical review process
  • Ensure compliance with established clinical guidelines, policies, and regulatory requirements
  • Review and analyze medical records to assess the appropriateness and necessity of healthcare services
  • Evaluate good faith estimates and “prebills” to determine scheduled care, including highlighting care that may not be included in the estimate (labs, radiology, pre-op visits, etc)
  • Collaborate with healthcare providers to gather additional information when needed
  • Drafts letters to send to members outlining benefits and other considerations
  • Collaborate with provider team and Member care team to evaluate care shopping options
  • Review claims reconsiderations and appeals, providing expert guidance to ensure accurate processing and resolution of issues coverage determination
  • Assess claims for balance billing protections to ensure compliance with applicable regulations and internal policies
Desired Qualifications
  • Prior authorization experience(preferred)
  • Bachelor's degree

Sidecar Health provides health insurance plans that focus on affordability and transparency, including options compliant with the Affordable Care Act (ACA). The company allows members to see average cash prices for medical services upfront, helping them make informed decisions and avoid unexpected costs. Revenue is generated through member premiums, which cover medical services, while also benefiting from the difference between negotiated cash prices and premiums. Sidecar Health's goal is to empower members to take control of their healthcare expenses with straightforward and cost-effective insurance options.

Company Size

201-500

Company Stage

Series D

Total Funding

$328M

Headquarters

El Segundo, California

Founded

2018

Simplify Jobs

Simplify's Take

What believers are saying

  • Recent $165M Series D funding supports expansion and innovation in health insurance.
  • Partnership with Mark Cuban Cost Plus Drug Company lowers prescription drug costs for members.
  • ACA-compliant product line expansion increases market reach and consumer options.

What critics are saying

  • Increased competition from similar insurtech companies may erode market share.
  • Regulatory scrutiny on cash pay models could pose compliance challenges.
  • Economic downturns might reduce consumer spending on health insurance premiums.

What makes Sidecar Health unique

  • Sidecar Health offers transparent pricing, empowering members with upfront healthcare cost information.
  • The company provides customizable plans, aligning with individual coverage needs and budgets.
  • Partnerships with institutions like Ohio State University enhance their fixed-price care model.

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Benefits

Health Insurance

Dental Insurance

Vision Insurance

401(k) Retirement Plan

Paid Vacation

Paid Holidays

Stock Options

Company Equity

Growth & Insights and Company News

Headcount

6 month growth

-1%

1 year growth

0%

2 year growth

0%
PR Newswire
Dec 19th, 2024
Sidecar Health And The Ohio State University Wexner Medical Center Announce Groundbreaking Fixed-Price Care Agreement

COLUMBUS, Ohio, Dec. 19, 2024 /PRNewswire/ -- Sidecar Health, a pioneering consumer-driven health insurance carrier, today announces a new, transparent pricing agreement with The Ohio State University Wexner Medical Center, home to the third-largest cancer hospital in the United States. This innovative agreement represents a significant advancement in transparent healthcare pricing and marks the first agreement of its kind for the academic medical center. Sidecar Health members will benefit from a fixed-price model that removes traditional barriers such as prior authorizations, unpredictable claim editing, and complicated medical management programs. This streamlined approach allows members to access advanced care at any Ohio State University medical facility, including The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J

Modern Healthcare
Jun 27th, 2024
Top digital health funding: Ashton Kutcher VC backs obesity care

Insurance technology company Sidecar Health said it raised $165 million in Series D financing, with Koch Disruptive Technologies leading the round.

Hit Consultant
Jun 27th, 2024
Sidecar Health Raises $165M for Expansion

Sidecar Health raised $165 million in a Series D funding round led by Koch Disruptive Technologies, with participation from investors like GreatPoint Ventures and Menlo Ventures. The funding and a strategic partnership with Koch Industries aim to disrupt the employer-sponsored health insurance market. Sidecar Health plans to expand to Florida, leveraging its model that offers transparency, eliminates prior authorizations, and promises 20% cost savings compared to traditional plans.

PR Newswire
Jun 26th, 2024
Sidecar Health Selects Koch Disruptive Technologies to lead $165M Series D Financing

/PRNewswire/ -- Sidecar Health, a transformative health insurance company providing major medical coverage to businesses, announced today the closure of $165...

Drug Store News
Jan 10th, 2024
Mark Cuban Cost Plus Drug Company partners with Sidecar Health

Mark Cuban Cost Plus Drug Company is partnering with Sidecar Health, an insurance company, to help bring high-quality, lower-cost prescription drugs to Sidecar Health members.