Senior Clinical Quality Nurse

Job overview

Senior Clinical Quality Nurse is a remote role for candidates residing in Arizona, Florida, Georgia, Illinois, Iowa, Kansas, Michigan, Missouri, Nebraska, New Jersey, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, or Virginia. The stated annual base pay is $75,265–$98,785 in most listed locations and $83,628–$109,761 in California, Connecticut, New Jersey, New York, and Washington; occasional travel may be required for team meetings and company events. Oscar’s Clinical Quality programs aim to improve clinical outcomes and member service. The nurse drives clinical performance through quality audits and reviews of care, helping departments meet their goals and regulatory requirements. The role also supports audit readiness, provides coaching and feedback, and collaborates with stakeholders on trends, training, and process improvements.

What you'll do

• Audit clinical documentation and provider cases
• develop audit surveys and rubrics
• track audit results
• support NCQA and other regulatory audit readiness
• conduct delegate oversight audits and prepare reports
• collaborate on corrective action plans
• provide feedback and coaching
• support training tools
• report quality trends
• participate in audit calibration and interrater reliability processes
• comply with applicable laws and regulations.

What we're looking for

Skills & competencies

senior clinical quality nurse

remote

oscar health

clinical quality

registered nurse

quality audits

utilization review

clinical documentation

ncqa

member outcomes

audit readiness

occasional travel

Work arrangement

• Weekend coverage required

Benefits & perks

• Medical, dental, and vision benefits
• 11 paid holidays
• paid sick time
• paid parental leave
• 401(k)
• life and disability insurance
• paid wellness time and reimbursements
• unlimited vacation program
• annual performance bonuses.

Why this role

Requires an active, unrestricted Registered Nurse license in the state of residence, 2+ years of Registered Nurse experience, 2+ years in a clinical care setting, and 1+ year of utilization review experience. Occasional travel may be required.

About the employer

Oscar Health is hiring for this role. Industry: Direct Health and Medical Insurance Carriers. Sector: 52.