Complex Case Management Nurse

Remotemid

OperationsOtherManagementHealthcare

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Quick Summary

Key Responsibilities

Assist in the coordination of care across a variety of settings (inpatient, outpatient, post acute, ER,

Requirements Summary

Active, unrestricted RN licensure from the United States in [state], OR,

Technical Tools

OperationsOtherManagementHealthcare

Hi, we're Oscar. We're hiring a Complex Case Management Nurse to join our CCM Team.

Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.

About the Role

~1 min read

You will educate members on improving health outcomes, assist with transitions from care settings, participate in process improvement and other pilot programs as they arise, and work with support teams to ensure exceptional care for our members.

You will report into the Associate Director, Clinical.

Responsibilities

~1 min read

→Assist in the coordination of care across a variety of settings (inpatient, outpatient, post acute, ER, home care)
→Actively reach out to members undergoing difficult health challenges and develop care plans
→Proactively reach out to hospital case managers to assist with discharge planning
→Communicate with members via phone or secure messaging to provide education on health conditions, new medications, and procedures
→Ensure compliance with all CCM NCQA standards in day to day practice and workflows.
→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
→Ability to obtain additional state licenses to meet business needs
→2+ years of clinical experience to include payer, hospital, outpatient or community based care management
→1+ years of experience in Care Coordination and Navigation

Nice to Have

~2 min read

CCM Certification
NCQA knowledge and accreditation experience
Bilingual in spanish and or creole reading, writing, speaking
BSN
Working knowledge of Milliman Guidelines

This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here.

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.

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