Utilization Review Nurse Manager

Oscar, California

A better kind of health insurance company

At Oscar, we work hard to provide the kind of health insurance we would want for ourselves. This means that we get to be creative and to build an excellent health insurer from the ground up.

We're looking for experienced clinicians to join the fast-growing Utilization Management/Clinical Review team. We're working to bring a new level of service to utilization review and ensure Oscar members receive access to appropriate care in a timely, transparent way. As a Utilization/Clinical Review Nurse Manager, you will manage and support a team of utilization review nurses, oversee day-to-day nurse operations, perform quality audits and performance reviews, as well as conducts some medical necessity review with medical appropriateness of inpatient and outpatient services by reviewing clinical information and applying evidence-based guidelines alongside the nursing team. You will also interact with Oscar providers, internal team members and internal/external key stakeholders as the point of contact and for collaboration.

Your primary responsibility in this role will be to support and manage a team of nurses. In order to do so, you will need to:

  • Demonstrate the highest level of professionalism, accountability, and service in your interactions with Oscar teammates, customer service, providers, and members
  • Learn and use Oscar tools and processes to perform and properly track all utilization reviews, as well to refer members for further care engagement when needed
  • Built strong relationships with the cross-functional company partners (you’ll be collaborating with a wide range of teams, as well as the Oscar leadership team).
  • Collect and give feedback accordingly to the team and leadership
  • Develop the nursing team and act as a mentor
  • Develop a working familiarity with applicable regulatory and accreditation requirements  
  • Perform and participate in quality improvement activities as requested and
  • Conduct performance reviews
  • Provide feedback into improving Oscar's overall operations and member/provider experience
  • Maintain continued professional growth and education to meet continuing education requirements and demonstrate knowledge & understanding of current nursing care practice
  • Meet required decision-making timeframes, including promptly triggering escalation for cases requiring physician review
  • Clearly document all communication and decision-making within our utilization review tracking platform, ensuring a peer could easily reference and understand your decision

Required experience and qualifications include:

  • Licensure:
    • Active, unrestricted RN (BSN & MS preferred) license
    • Willingness to obtain additional state licenses as needed for Oscar's growth (with Oscar's support)
  • Experience of at least:
    • Four to five years utilization review experience at a managed care plan or provider organization and
    • Five to seven years healthcare experience (including at least three years in clinical practice in an acute care setting) and
    • Two years of managerial experience preferred
  • Professional skills:
    • Able to multi-task and manage tasks to completion on a timely basis and in an organized fashion
    • Comfortable with technology; willing and able to learn new software tools
    • Clear written and spoken communication, including a poised phone presence
    • Flexible mindset: we are a fast-moving and evolving startup
    • Building, coaching, developing teams.


At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we work to cultivate an environment where exceptional people can be their most authentic selves and find both belonging and support. We're on a mission to change healthcare -- an experience made whole by your unique background and perspectives.

About Oscar

Founded in 2012, Oscar is probably the last thing you would expect from a technology startup – a seemingly old-fashioned healthcare insurance provider. The company provides clients with the kind of clarity and simplicity we have come to expect from an e-commerce site. And, of course, they're hiring.

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Want to learn more about Oscar? Visit Oscar's website.