Sr. Quality of Care Review Nurse

ABOUT THE ROLE We're Oscar, a health insurance company built around a full stack technology platform and a relentless focus on serving our members. We're seeking a Senior Quality of Care Review Nurse to join our Quality team, driving clinical performance through quality auditing and clinical quality of care review processes. This role involves reviewing services provided to members from network healthcare providers, facilities, and Oscar employees, with a focus on enhancing clinical outcomes and concierge-level service. WHAT YOU'LL DO As a Senior Clinical Quality Nurse, you will perform quality audits of internal and external member, provider, and delegated vendor interactions. You will guide interrater reliability assessments, support evidence-based clinical decision-making, and ensure workflow adherence. You will also investigate provider and facility quality of care concerns, identifying and escalating negative performance trends for corrective action. Additionally, you will consult with company partners to ensure that programs developed meet changing organizational needs while following accreditation and regulatory requirements. WHAT YOU'LL NEED To be successful in this role, you will need to be a Licensed Registered Nurse with an active, unrestricted license in the state of residence. You will also need 2+ years of experience as a Registered Nurse, with 2+ years of experience working in a clinical care setting. A Bachelor's Degree from an accredited university, BSN preferred, is also required. WHY REMOTE This is a remote position, open to candidates who reside in Arizona, Florida, Georgia, or Texas. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events. BENEFITS As a full-time employee, you will be 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. The base pay for this role is $83,628 - $109,761.75 per year, with the possibility of annual performance bonuses.