ApplySarthiUtilization Review Nurse
Oscar Health
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This role on the market
10 open utilization roles across 6 companies are on ApplySarthi right now.
- Tech Infra Program Manager, DC Power Utilization ManagementAmazon Data Services, Inc.
- Utilization Management Administration Coordinator - SNFHumana
- Utilization Management Specialist IIJobgether
- Distinguished Technologist - Memory/Storage Utilization & Data Placement ArchitectHp
- Medical Director, Utilization Management (Home Health, Acute & Post-Acute)Clover Health
What utilization roles keep asking for: AWS (40%) — counted across their open postings here.
Oscar Health has 280 open roles listed here.
- Bilingual Medical Assistant (Part-Time)
- Manager, Risk Adjustment, Provider Partnerships
- Senior Clinical Quality Nurse
- Senior Analyst, Data Analytics, SIU
- Senior Analyst, Data Analytics, SIU
Counted across 14 company job boards, updated as roles open and close.
Preparing for this interview
Interviews for utilization roles keep coming back to AWS. Practise those questions before you sit with Oscar Health.
Questions you are likely to be asked
- Why do you want to join Oscar Health?
- Where do you want to be in three years?
- What is a weakness you are working on, and how?
- Tell me about yourself, and why this role is the right next step.
- Tell me about a problem you solved at work that you are proud of.
Prep Sarthi gives you a free mock interview: an AI interviewer asks you questions like these out loud, from your own CV and this job, and shows your score and your weakest answer.
Practise the Utilization Review Nurse at Oscar Health interview free →Hi, we're Oscar. We're hiring a Utilization Review Nurse to join our Utilization Review team.
About the role:
You will perform frequent case reviews, check medical records and speak with care providers regarding treatment as needed. You will make recommendations regarding the appropriateness of care for identified diagnoses based on the research results for those conditions.
You will report into the Supervisor, Utilization Review.
Work Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois; Iowa; Kansas; Michigan; Missouri; Nebraska; New Jersey; North Carolina; Ohio; Pennsylvania; South Carolina; Tennessee; Texas; or Virginia. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events.
Pay Transparency: The base pay for this role is: $35.00 - $45.94 per hour. You are also eligible for employee benefits and monthly vacation accrual at a rate of 15 days per year.
Responsibilities:
- Complete medical necessity reviews and level of care reviews for requested services using clinical judgment and Oscar Clinical Guidelines, Milliman Care Guidelines
- Obtain the information necessary (via telephone and fax) to assess a member's clinical condition, and apply the appropriate evidence-based guidelines
- Meet required decision-making SLAs
- Refer members for further care engagement when needed
- Compliance with all applicable laws and regulations
- Other duties as assigned
Requirements:
- Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC)
- Associate Degree - Nursing or Graduate of Accredited School of Nursing Or Successful completion of Nursing Diploma Program in Accredited School of Nursing
- Ability to obtain additional state licenses to meet business needs
- 1+ year of utilization review experience in a managed care setting
- Strong experience utilizating MCG (Milliman Care Gudielines) or InterQual
- 1+ years of clinical experience (including at least 1+ year clinical practice in an acute care setting, i.e., ER or hospital)
- Weekend availability is required; all applicants must be able to work at least one weekend day (Saturday or Sunday) each week.
Bonus points:
- BSN
- Previous experience conducting concurrent or inpatient reviews for a managed care plan
This is an authentic Oscar Health job opportunity.
At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.
Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.
Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.
Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant’s disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known.
California Residents: For information about our collection, use, and disclosure of applicants’ personal information as well as applicants’ rights over their personal information, please see our Privacy Policy.
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Listed on greenhouse · posted 2026-09-16. ApplySarthi collects openings and links to application pages; the role is advertised by Oscar Health, not by us.