Clinical Quality Nurse

Hi, we're Oscar. We are hiring a Senior Clinical Quality nurse to join our 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:

Clinical Quality programs are designed to enhance clinical outcomes and concierge-level service to our members, through review of services provided to members from network healthcare providers, facilities and Oscar employees. The Senior Clinical Quality Nurse drives clinical performance through the quality auditing and clinical quality of care review process for the departments they serve. The Clinical Quality Nurse serves as a peer mentor and a consultant, working collaboratively with team members to implement audit programs that reflect departmental goals and measurements, meeting all regulatory and organizational requirements.

You will report into the Nurse Supervisor, UM Clinical Quality.

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 in the states of California, Connecticut, New Jersey, New York, and Washington is: $83,628 - $109,761 per year. The base pay for this role in all other locations is: $75,265 - $98,785 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.

Responsibilities:

• Perform quality audits on clinical documentation for clinicians from a variety of clinical departments.
• Develop audit surveys and rubrics to ensure the transparency of audit requirements, supporting evidence-based clinical decision making and adherence to department workflows and align with regulatory accreditation requirements.
• Pull clinician and provider cases for auditing purposes, tracking results in department systems and tracking mechanisms.
• Support organizational readiness and preparation for NCQA and other regulatory audits.
• Perform delegate oversight audits, writing audit result summary reports and presenting to stakeholders and delegates. Collaborate with leadership to develop corrective action plans to address identified gaps.
• Provide 1:1 feedback and coaching to front-line staff and leaders regarding departmental workflows and audit requirements and support developing training tools on quality best practices, audit standards and other topics as directed.