Hi, we're Oscar. We're hiring a Utilization Review Appeals RN to join our Utilization Review team.

About the role

The appeals & claims UR nurse is responsible for the investigation and review of clinical appeals and post-claim cases. This involves using clinical knowledge, judgment, and established criteria to determine the medical appropriateness of healthcare services, including inpatient and lower level of care admissions, as well as a variety of outpatient and specialty services. Appeals nurses work as individual contributors completing reviews, and interact regularly with Oscar medical providers and other internal operations teams to successfully fulfill their role.

You will report into the Clinical Appeals Manager.

This is a work-from-home/remote 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.

The ...