Oscar Health · 6 hours ago
Senior UM Review Nurse
United States
Full-time
Remote
Mid, Senior Level
$40.21/hr - $52.77/hr
2+ years expOscar is a health insurance company built around a full stack technology platform focused on serving its members. The Senior UM Review Nurse will leverage clinical knowledge to determine the medical appropriateness of healthcare services and act as a subject matter expert while collaborating with peers and internal teams.
Health CareHealth InsuranceInsuranceInsurTech
Responsibilities
Gather relevant medical information (via internal resources, ticket, and document review) and complete medical necessity and level of care reviews using clinical judgment and the Plan's clinical guidelines
Meet required decision-making timeframes, including promptly triggering escalations requiring physician review
Write clear and concise reviews of inpatient & lower level of care admissions, as well as outpatient and specialty service requests
Comply with department performance and quality metrics, and adhere to training and remediation requirements
Support nurse supervisor & managers in daily queue oversight including identifying and flagging clinical trends/issues
Effectively use Oscar tools to investigate and perform utilization reviews, and to support queue oversight and staffing
Acts as a clinical resource and escalation point for peers, assists in precepting of newly hired nurse reviewers, and serve as continual champions of the Oscar mission
Contribute to root cause analysis and process improvement initiatives
Use working knowledge and familiarity with applicable utilization management regulatory and accreditation requirements on a day to day basis to ensure accurate reviews
Act as subject matter experts and support the supervisory team in that capacity
Compliance with all applicable laws and regulations
Other duties as assigned
Qualification
Required
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)
Associate Degree and/or Bachelors of Nursing from an accredited school of nursing
2+ years of utilization review experience at a managed care plan or provider organization
2+ years healthcare experience
MCG Experience
1+ years of clinical practice in an acute care setting
Preferred
Bachelors of Nursing (BSN) degree
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