Nurse Manager, Quality of Care

Hi, we're Oscar. We're hiring a Nurse Manager to join our Clinical Quality team.

Oscar is the first health insurance company built around a full stack technology platform and a 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

You will play a key role in driving clinical and operational performance within their department by ensuring all department activities are carried out in a clinically appropriate manner observing organizational processes and evidence-based resources. You will work with direct reports, providers, external and internal stakeholders to review clinical services provided to Oscar members for clinical appropriateness and adherence to organizational and regulatory requirements. You will partner with key contacts across the organization, communicating results and recommendations for improvement across disciplines. The Nurse Manager grows clinical teams through the direct leadership of leaders and staff, playing a key role in driving the achievement of department quality and productivity metrics, goals and KPIs. You will use subject matter expertise and clinical knowledge to address escalated issues.

You will report to the Director, Quality Monitoring and Improvement.

Work Location: 

Oscar is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture and our mission. 

If you live within commutable distance to our New York City office (in Hudson Square), our Tempe office (off the 101 at University Dr), or our Los Angeles office (in Marina Del Rey), you will be expected to come into the office at least two days each week. Otherwise, this is a remote / work-from-home role. 

You must reside in one of the following states: Alabama, Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, Virginia, Washington, or Washington, D.C. Note, this list of states is subject to change. #LI-Remote

Pay Transparency:

The base pay for this role is: $108,000 - $141,750 per year. You are also eligible for employee benefits, participation in Oscar’s unlimited vacation program and annual performance bonuses

Responsibilities

• Provide input in creating and maintaining, based on regulatory, accreditation, and organizational requirements,  policies and procedures defining the completion of all department functions to help ensure they meet the needs of our members, providers and internal/external stakeholders. 
• Oversee daily operations to ensure team work assignments are completed within established turnaround times and in accordance with department policies and procedures, regulatory and accreditation requirements.
• Monitor team dashboards, review and analysis of productivity reporting, completion of quality audits and other data to monitor individual and team performance.
• Maintain expertise on department tools and platforms to inform analysis.
• Analyze data to identify performance trends/opportunities for improvement and work  with data analytics to ensure productivity and quality data provides actionable insights on team/individual performance against goals.
• Create corrective action plans or performance improvement plans to address identified opportunities.
• Drive a culture of accountability and recognition that aligns with department objectives and increases employee engagement. 
• Provide coaching, development and performance management to staff and leaders, evaluating performance against goals throughout the year.
• Compliance with all applicable laws and regulations
• Other duties as assigned

Qualifications

• Bachelor of Science in Nursing
• Active, unrestricted Nursing license (RN) in the state of hire and ability to obtain additional licensure 
• 4+ years of experience in a healthcare setting as a nurse 
• Strong computer literacy, able to work effectively in multiple platforms
• 2+ years leading a clinical team at a managed care plan or healthcare organization including in a virtual environment

Bonus Points

• Experience performing quality of care investigations or quality auditing or compliance oversight for a healthcare organization.
• Proficiency using case ticketing systems e.g. Jira or Appian to prioritize & document team activities.
• 1+ years leading and/or implementing process improvement initiatives/Six Sigma or large scale projects
• 1+ years of experience working in production/operations including case prioritization/case triage 
• Proficiency in creating and working with Google Sheets, Slides, Docs and using applications to create presentations to stakeholders, and senior leadership.
• Experience communicating with senior leadership in a live (virtually or in-person) setting or through email
• Experience leading employees and presenting to large groups in a virtual environment.
• Working knowledge of NCQA and state/federal regulatory requirements for the areas served by the team
• Working knowledge of utilization management clinical decision-making criteria (milliman care guidelines)