---
title: 'Utilization Review Nurse at Oscar Health'
canonical: 'https://feeny.ai/job/utilization-review-nurse-oscar-health-remote-1ckm1sk3pnzs'
type: 'job'
last_seen: '2026-09-17'
---

# Utilization Review Nurse at Oscar Health

- **Company:** Oscar Health
- **Location:** Remote
- **Work type:** remote
- **Posted:** 2026-09-16
- **Last confirmed live:** 2026-09-17
- **Apply:** https://job-boards.greenhouse.io/oscar/jobs/8172223

## Job description

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](https://oscarhealth.com/careers/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](https://oscarhealth.com/privacy-policy).

## About Oscar Health

## Company Overview
- **One-liner**: Oscar Health is a healthcare technology company that builds a full-stack health insurance platform to make high-quality, affordable healthcare accessible for individuals, families, and employers.
- **Entity Type**: Public (NYSE: OSCR)
- **Headquarters**: New York City, USA (TriBeCa)
- **Founded**: 2012
- **Founders**: Mario Schlosser (CTO & Co-Founder); additional co-founders are not publicly detailed in the provided sources.

## Core Business
- **Primary industry**: Health insurance / healthcare technology
- **Target customers**: B2C (individuals, families, Medicare beneficiaries) and B2B (employers through Small Group plans and ICHRA)
- **Mission**: “Make a healthier life accessible and affordable for all.”

## Products & Services
- **Oscar Individual & Family Plans** – Health insurance sold on- and off-exchange, featuring $0 virtual urgent care, $3 generic medications, and dedicated Care Teams.
- **Medicare Advantage** – Medicare health plans launched in 2020, available in select states.
- **Oscar for Employers (Small Group / ICHRA)** – Employer-sponsored health benefits, including Individual Coverage Health Reimbursement Arrangements (ICHRA).
- **Oscar Provider Platform** – A technology platform that connects providers with Oscar’s member engagement tools.
- **Oscar App & Care Router** – Digital engagement platform that routes members to appropriate care (virtual or in-person) and enables 24/7 communication with a Care Team.

## Market Standing
- **Valuation/Market Cap**: Not directly provided in the search results; as a public company, market cap is available via SEC filings (e.g., ~$6B as of recent market data, but not confirmed in these sources).
- **Key Metric**: Serves approximately 1.6 million members as of August 2024 (the company also reports a figure of ~3.2 million members, possibly including additional plan types or a different measurement).
- **Notable Investors/Partners**: Not specified in the provided search results; the company went public in 2021 and counts major venture firms among its early investors.
- **Growth Signals**: Active in 20 states; member base grew from 1 million in 2022 to over 1.6 million; launched Medicare Advantage in 2020; has 238 active job postings as of the search date, indicating expansion.

## Competitive Advantages
- **Full-stack technology platform** – Oscar owns the entire insurance stack (claims, care management, provider network), enabling data-driven personalization and member engagement.
- **High member trust and engagement** – 68% of members trust Oscar for care guidance; 44% are digitally engaged; Net Promoter Score of 66; 76% have interacted with digital or Care Team channels.
- **Care Team model** – Every member is assigned a dedicated Care Team that coordinates care, reduces costs, and improves outcomes.
- **Virtual care integration** – $0 virtual urgent care with 97% member satisfaction; virtual primary care in some markets.

## Strategic Focus
- **Geographic expansion** – Entering new states and markets, including Medicare Advantage.
- **AI and technology** – Actively investing in AI to improve care routing, cost savings, and member experience (see “AI @ Oscar” page).
- **Provider platform growth** – Scaling the Oscar Provider Platform to partner with independent providers and health systems.
- **Employer market** – Expanding ICHRA and Small Group offerings to reach more businesses.

## Why Work Here
- **Mission-driven culture** – “Change healthcare for good” with a focus on making insurance simple, transparent, and human. Values include transparency, grit, scientific thinking, and “members above all.”
- **Comprehensive benefits** – Health insurance (obviously), 10+ weeks of parental leave, wellness days, fitness classes, mental health support, 401(k) plan, HSAs, and learning & development programs.
- **Offices** – Headquarters in New York City (TriBeCa), plus offices in Los Angeles (Silicon Beach) and Tempe, Arizona (Health Hub). Remote/hybrid policy not explicitly stated, but many roles appear location-flexible.
- **Growth opportunity** – With 238 open positions and recent member growth, employees can work on challenging problems at scale.
- **Diverse and inclusive environment** – Publishes a diversity report and emphasizes belonging; employees describe culture as collaborative and high-impact.

## Sources
1. [hioscar.com/about](https://www.hioscar.com/about)
2. [hioscar.com/careers](https://www.hioscar.com/careers)
3. [hioscar.com/careers/life](https://www.hioscar.com/careers/life)
4. [linkedin.com/company/oscar-health](https://www.linkedin.com/company/oscar-health)
5. [hioscar.com](https://www.hioscar.com/)

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