Utilization Review Nurse

New

Skills

Clinical Assessment Decision-Making InterQual Tooling Managed Care MCG Guidelines Nursing Licensure Patient Care Engagement Regulatory Compliance Remote Work Utilization Review

The Utilization Review Nurse is responsible for performing medical necessity and level-of-care reviews in accordance with Oscar guidelines. This position involves gathering clinical records to assess patient conditions and applying established guidelines to ensure compliance and effective decision-making.

Key Responsibilities
  • Complete medical necessity and level-of-care reviews per Oscar guidelines.
  • Gather clinical records via phone and fax to assess clinical conditions.
  • Meet required decision-making service level agreements (SLAs).
  • Refer members for further care engagement as necessary.
  • Ensure compliance with all applicable laws and regulations.
  • Perform other duties as assigned.
Required Skills & Qualifications
  • Active, unrestricted RN license in the US or compact multistate RN license per NLC.
  • Associate or Bachelor's degree in Nursing.
  • Experience with MCG or InterQual tooling.
  • Ability to obtain additional state licenses to meet business needs.
  • 1+ year of utilization review experience in managed care.
  • 1+ year of clinical experience in acute care settings (ER or hospital).

No forms. Your profile is generated instantly.

Job Type: Remote

Salary: Not Disclosed

Experience: Entry

Duration: Months

Share this job:

Similar Jobs

Ambulatory Care Pharmacist

Posted 27 days ago

Provide comprehensive medication management.

Collaborate with healthcare professionals for individualized care.

Clinical Assessment Communication Skills Cost-Optimization Strategies Medication Management

Physical Therapist Position

Posted 21 days ago

Provide high-quality, one-on-one patient care.

Develop action plans based on thorough assessments.

Clinical Assessment Clinical Reasoning Collaboration Communication Skills

Outpatient Orthopedic Physical Therapist

Posted 27 days ago

Provide outpatient orthopedic physical therapy to patients.

Offer mentorship and growth opportunities for all levels.

Clinical Assessment Communication Skills Evidence-Based Practice Leadership Development

Pelvic Physical Therapist

Posted 23 days ago

Set clear expectations for patient progress.

Execute promised treatments effectively.

Clinical Assessment Continuing Education Empathy in Care Home Exercise Program Development

Physical Therapist Director

Posted 21 days ago

Develop personalized, evidence-based care plans for patients.

Provide high-quality, outcomes-centric care.

Clinical Assessment Community Engagement Continuing Education Evidence-Based Practice

Physical Therapist Role

Posted 21 days ago

Provide one-on-one high-quality care.

Utilize clinical reasoning for client progress.

Action Planning Clinical Assessment Clinical Reasoning Collaboration

PRN Physical Therapist

Posted 9 days ago

Develop individualized, evidence-based care plans for patients.

Deliver high-quality and outcomes-driven therapy.

Clinical Assessment Collaboration Communication Continuous Education

Physical Therapist Role

Posted 17 days ago

Deliver high-quality patient care.

Utilize clinical reasoning for treatment plans.

California License Clinical Assessment Clinical Education Clinical Reasoning

Physical Therapist Position

Posted 17 days ago

Deliver high-quality physical therapy services.

Engage local referral partners for patient acquisition.

Action Planning Clinical Assessment Clinical Reasoning Coaching Mindset

Physical Therapist Position

Posted 15 days ago

Develop individualized care plans for patients.

Deliver high-quality, outcomes-driven therapy.

Clinical Assessment Communication Skills Continuing Education Evidence-Based Practice

Outpatient Orthopedic Therapist

Posted 14 days ago

Provide outpatient orthopedic physical therapy.

Develop individualized care plans.

Care Coordination Clinical Assessment Evidence-Based Practice Mentorship

Naturopathic Doctor Position

Posted 13 days ago

Provide high-quality patient care.

Conduct comprehensive consultations.

Clinical Assessment Consultation Skills DEA Compliance EMR Documentation

Physical Therapist Position

Posted 12 days ago

Develop individualized care plans.

Deliver outcomes-driven therapy.

Clinical Assessment Collaboration Communication Skills Continuous Learning

Registered Nurse Position

New

Provide flexible scheduling for nurses.

Deliver one-on-one patient care.

Client Monitoring Clinical Assessment Communication Skills Documentation Skills

Physical Therapist Position

Posted 7 days ago

Develop individualized care plans for patients.

Provide outcomes-driven therapy services.

Clinical Assessment Communication Skills Continuing Education Documentation Skills

Complex Case Management Nurse

Posted 7 days ago

Coordinate care across various settings.

Develop care plans for complex health challenges.

Care Coordination Care Management Clinical Assessment Clinical Experience

Outpatient Orthopedic Therapist

New

Provide outpatient orthopedic therapy to patients.

Develop individualized, evidence-based care plans.

Administrative Support Clinical Assessment Communication Skills Continuing Education

Physical Therapist Position

New

Deliver high-quality outpatient physical therapy.

Develop individualized, evidence-based care plans.

Care Plan Development Clinical Assessment Collaboration Evidence-Based Practice

Physical Therapist Position

Posted 6 days ago

Develop individualized care plans.

Provide high-quality therapy services.

Care Plan Development Clinical Assessment Collaboration Communication Skills

Physical Therapist Role

Posted 6 days ago

Develop individualized care plans for patients.

Deliver outcomes-driven therapy services.

Clinical Assessment Collaboration Communication Skills Evidence-Based Practice

Outpatient Orthopedic Therapist

Posted 6 days ago

Provide outpatient orthopedic physical therapy services.

Encourage collaboration to develop individualized care plans.

Clinical Assessment Communication Skills Continuing Education Individualized Care Plans

Physical Therapist Role

Posted 5 days ago

Develop individualized care plans for patients.

Deliver high-quality therapy focused on outcomes.

Care Plan Development Clinical Assessment Communication Skills Continuous Education

Physical Therapist Position

Posted 3 days ago

Develop individualized care plans for patients.

Provide high-quality therapy services.

Clinical Assessment Clinical Documentation Collaboration Evidence-Based Practice

Outpatient Orthopedic Physical Therapist

Posted 3 days ago

Deliver outpatient orthopedic physical therapy.

Develop individualized care plans.

Care Plan Development Clinical Assessment Communication Skills Evidence-Based Care

Physical Therapist Position

New

Develop individualized, evidence-based care plans.

Deliver high-quality, outcomes-driven therapy.

Care Planning Clinical Assessment Collaboration Communication Skills

Outpatient Orthopedic Physical Therapist

New

Provide orthopedic physical therapy to patients.

Develop individualized care plans.

Care Plan Development Clinical Assessment Collaboration Communication Skills

Physical Therapist Position

New

Provide high-quality outpatient orthopedic PT.

Develop individualized care plans.

Care Plan Development Clinical Assessment Communication Skills Evidence-Based Practice

Outpatient Orthopedic Physical Therapist

New

Provide outpatient orthopedic physical therapy.

Offer flexible work schedules: full-time, part-time, PRN.

Clinical Assessment Communication Skills Documentation Mentorship

Physical Therapist Position

New

Focus on providing high-quality patient care.

Support for new graduates through structured onboarding and mentorship.

Care Plan Development Clinical Assessment Evidence-Based Practice Georgia PT Licensure

Outpatient Orthopedic PT

New

Provide outpatient orthopedic physical therapy.

Develop individualized care plans.

Clinical Assessment Communication Skills Evidence-Based Practice Georgia PT License

Physical Therapist Position

New

Develop individualized care plans for patients.

Provide structured onboarding for new graduates.

Clinical Assessment Communication Skills Documentation Technology Evidence-Based Practice

Technical Program Manager II

Posted 27 days ago

Identify and manage security risks.

Drive decisions for key security initiatives.

AI Tools Utilization Cybersecurity Knowledge Decision-Making Metrics and Reporting

Senior Account Executive

Posted 23 days ago

Create and manage sales opportunities.

Maintain an organized sales pipeline.

Bilingual Communication Client Relationship Management CRM Software Decision-Making

Safeguarding Associate Field Manager

Posted 9 days ago

Lead safeguarding design and execution for emergency contexts.

Conduct rapid risk assessments in emergency situations.

Analytical Skills Cross-Cultural Communication Decision-Making Emergency Response

Executive Assistant Position

New

Maintain confidentiality of information.

Coordinate meetings and events for senior leadership.

Collaboration Confidentiality Management Decision-Making Expense Management

Senior Enterprise Pursuit Executive

New

Identify and develop new enterprise opportunities.

Build relationships with senior security leaders.

Account Strategy Cybersecurity Decision-Making Enterprise Sales

Legal Counsel, Fintech Remote

Posted 38 days ago

Provide comprehensive legal support across business functions

Ensure compliance in commercial and product operations

Compliance Corporate Governance Regulatory Compliance

Regional Compliance Officer

Posted 38 days ago

Lead regional compliance oversight for Airtm in India.

Implement and monitor AML/CFT measures for the region.

Anti-money Laundering Audit Communication Compliance

Legal Counsel - Airtm

Posted 38 days ago

Provide legal counsel on high-profile projects

Draft and negotiate contracts with various partners

Compliance Corporate Governance Licensing Project Management

Sales Floor Leader

Posted 38 days ago

Drive sales goals, Provide exceptional customer service, Manage inventory levels, Enforce company

licies, Support store

Communication Skills Financial Acumen Interpersonal Skills Organizational Skills

AML Analyst Position

Posted 38 days ago

* Review transaction monitoring alerts * Assess adverse media and PEP alerts * Prepare SAR

Conduct due diligence for high-risk customers * Support policy drafting and compliance

Blockchain technology Due Diligence Financial Services Regulatory Compliance

Benefits Analyst Position

Posted 38 days ago

Assist in benefits administration, Drive benefits function, Ensure compliance with laws, Manage

or relationships, Collaborate with

Microsoft Excel Project Management Regulatory Compliance Vendor Management

Enterprise Risk Management Analyst

Posted 38 days ago

Develop and operationalize enterprise risk management programs

Assess and monitor enterprise-wide risks and internal controls

Analyst Communication Compliance Documentation

Senior Counsel - Employment Compliance

Posted 38 days ago

Lead global employment and compliance strategy

Spearhead Future of Work in AI

Analytical Skills Communication Communication Skills Compliance

Global Geo Expansion Manager

Posted 38 days ago

Drive global market expansion initiatives

Align regulatory and compliance strategies

Business Development Cross-functional Collaboration Excel Financial Modeling

Business Development, Crypto Equities

Posted 38 days ago

Expand tokenized equities adoption

Drive high-impact strategic partnerships

Blockchain Business Development Capital Markets Partnerships

Geo Expansion Manager Role

Posted 38 days ago

Drive global market expansion

Ensure regulatory compliance and license acquisition

Business Development Cross-functional Collaboration Excel Financial Modeling

Principal Business Development xStocks

Posted 38 days ago

Drive strategic partnerships in crypto and blockchain.

Accelerate adoption of tokenized and traditional equities.

Blockchain Business Development Capital Markets Cryptocurrency

Legal Director (Wealth)

Posted 38 days ago

Provide legal and regulatory advice for wealth management roadmap - Draft agreements and

for products - Oversee governance and risk matters - Communicate complex legal concepts - Balance

Corporate law Legal Drafting Project Management Regulatory Compliance