Hi, we're Oscar. Were hiring a Medical Director, Utilization Management to join our Utilization Management team.
Oscar is a technology-driven, consumer-focused health insurance startup founded in 2012 & headquartered in New York City. Our goal is to make health insurance simple, transparent, & human. We need your help to do so.
About the role:
We are looking for an experienced physician to support Oscars fast-growing Utilization Management team. We are working to bring a new level of service to utilization review & ensure Oscar members receive access to appropriate care in a timely, transparent way.
As the Medical Director for Utilization Management, you will be one of the primary physician reviewers who determines the medical appropriateness of inpatient, outpatient & pharmacy services by reviewing clinical information & applying evidence-based guidelines. You will be a critical part of our clinical review team, including non-clinician processors, nurses & part-time physicians. You will report to the Senior Medical Director for Utilization Management. In this role, you will interact with Oscar providers & members, in addition to other parts of our medical operations team, including state medical directors, operational leads, & quality & pharmacy subject matter experts. You will support projects aimed at strengthening our utilization review function & team.
- Provide clinical determinations based on evidence-based criteria & Oscar internal guidelines & policies, while utilizing your clinical acumen
- Conduct timely peer-to-peer discussions with treating providers to clarify clinical information & to explain review outcome decisions, including feedback on alternate treatment based on medical necessity criteria & evidence-based research.
- Support reporting & regulatory needs for the utilization review function for quality & regulatory purposes as necessary
- Develop clinical protocols & policies to enhance the quality of medical necessity decision-making, incorporating input from the clinical review team, operations, & other medical operations leads (state medical directors, quality, pharmacy)
- Licensure: Board certification as an MD or DO with a current unrestricted license to practice medicine is required. Licensure in multiple Oscar states is preferred but not required (AZ, CA, & MI licensure is highly desirable); you should be willing to obtain additional state licenses, with Oscar's support. Reviewers must maintain necessary credentials to retain the position.
- 3+ years of clinical practice in one of the following fields: internal medicine, family medicine, general surgery, emergency medicine
- 3+ years of utilization review experience in a managed care plan (health care industry)
- Experience with care management within the health insurance industry.
- Experience with conducting quality-of-care investigations & peer reviews
- and developing performance improvement plans.
Life at Oscar:
At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves & find both belonging & support. We're on a mission to change health care -- an experience made whole by our unique backgrounds & perspectives.
We encourage our members to care for their whole selves, & we encourage our employees to do the same with comprehensive medical benefits, generous paid-time off, paid parental leave, retirement plans, company social events, stocked kitchens, wellness programs, & volunteer opportunities.
Oscar applicants are considered solely based on their qualifications, without regard to applicants disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (firstname.lastname@example.org) to make the need for an accommodation known.
Pay Transparency Policy:
Oscar ensures that you won't be discharged or discriminated against based on whether you've inquired about, discussed, or disclosed your pay. Read the full policy here.