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Salary: USD 75,265 - 109,761 / annual
Oscar Health is seeking a Senior Clinical Quality Nurse to drive clinical performance through quality auditing and clinical quality of care review processes. This remote role reports to the Nurse Supervisor, UM Clinical Quality, and is open to candidates residing in Arizona, Florida, Georgia, Illinois, Iowa, Kansas, Michigan, Missouri, Nebraska, New Jersey, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, or Virginia. Occasional travel may be required for team meetings and company events.
In this role, you will perform quality audits on clinical documentation across various clinical departments, develop audit surveys and rubrics aligned with regulatory accreditation requirements, and pull clinician and provider cases for auditing purposes. You will support organizational readiness for NCQA and other regulatory audits, perform delegate oversight audits, and write audit result summary reports for stakeholder presentation. You will provide 1:1 feedback and coaching to front-line staff and leaders, develop training tools on quality best practices and audit standards, and collaborate with leadership on audit trends and process improvements. Additionally, you will deliver quality-oriented presentations, aggregate quality data to report performance trends, participate in audit calibration sessions, and support interrater reliability processes to ensure consistent clinical decision-making across teams.
Oscar is the first health insurance company built around a full-stack technology platform with a focus on serving members through enhanced clinical outcomes and concierge-level service. The company was founded in 2012 with a mission to create health insurance that behaves like a doctor in the family.
**Requirements:**
- Licensed Registered Nurse with active, unrestricted license in state of residence; willingness to obtain additional licenses as needed (with Oscar's support)
- 2+ years of experience as a Registered Nurse
- 2+ years of experience working in a clinical care setting
- 1+ years of utilization review experience at a managed care plan or provider organization
**Preferred qualifications:**
- Health plan case management experience
- Healthcare quality assurance experience, including medical records auditing and clinical information evaluation
- Bachelor's Degree from an accredited university; BSN preferred
- Working knowledge of health insurance/benefit concepts; Medicare and Individual Marketplace experience a plus
- Strong understanding of NCQA accreditation standards for utilization management, case management, or population health; HEDIS measures and regulatory requirements
- CCM or MCG certification
- Experience analyzing and interpreting performance data
- Proficiency with Google applications (Sheets, Docs, Slides, Meets)
- Comfort using Google Meets and other platforms for stakeholder communication
