CCM Case Management RN

Hi, we're Oscar. We're hiring a CCM Case Management RN 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.

Telephonic case management role in which 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 the Clinical Concierge Specialist and other Oscar teams to ensure exceptional care for our members. 

You will report into the Manager, Clinical Programs.

• →Assist in the coordination of care across a variety of settings (ER, inpatient, post acute, outpatient, home care) while maintaining strict confidentiality and the highest level of professionalism.
• →Actively reach out to members undergoing difficult health challenges and help guide them through the healthcare system to improve their overall experience.
• →Complete a comprehensive biopsychosocial needs assessment to help identify member needs.
• →Develop an outcome-based plan of care, based on the member’s input and assessed clinical and social needs with anticipated targeted dates for accomplishment.
• →Conduct in-home and facility visits to engage and educate the member (and their family/caregivers).
• →Attend doctor appointments with members and collaborate with their providers to assist them in better understanding their plan of care.
• →Proactively reach out to hospital case managers to assist with safe discharge planning to appropriate level of care or home.
• →Seek guidance from medical directors to advocate for members to get the appropriate care they need. Act as a member advocate and assist with problem solving, as well as addressing any barriers to care or compliance with the care plan.
• →Educate other teams on the CCM program and collaborate to identify high risk members who would be appropriate.
• →Work with non-clinical teammates in assisting members to navigate the healthcare system, including coaching non-clinicians on how they can add value to all member interactions.
• →Communicate with members via phone, secure messaging, and in person to provide education on health conditions, new medications, and procedures.
• →Participate in surveys, studies, and special projects as assigned.

• 2+ years of clinical experience.
• Active, unrestricted Nursing license (RN) in your state of hire and ability to obtain additional licensure as needed.

• Working knowledge of Milliman Care Guidelines
• Case Management experience
• CCM certification BSN
• Previous work from home and proven comfort with accessing systems remotely
• Bilingual in Spanish or Creole