Physician Reviewer - Utilization Management at Oscar Health In Other

Physician Reviewer - Utilization Management
Oscar Health // health insurance

Hi, we're Oscar. We're hiring a Physician Reviewer to join our Utilization Management team.

Oscar is the first health insurance company built around a full stack technology platform & a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselvesone that behaves like a doctor in the family.

About the role:

You will determine the medical appropriateness of inpatient, outpatient, & pharmacy services by reviewing clinical information & applying evidence-based guidelines.

Hours: 8am - 5pm in your local time zone

Call rotation - 1 weekend every 16 weeks

You will report into the Associate Medical Director, Utilization Management.

Work Location: 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 & company events. #LI-Remote

Pay Transparency: The base pay for this role is: $211,200 - $ 277,200 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation, & annual performance bonuses.

Responsibilities:

Provide timely medical reviews that meet Oscar's stringent quality parameters.
Provide clinical determinations based on evidence-based criteria & Oscar internal guidelines & policies, while utilizing clinical acumen.
Clearly & accurately document all communication & decision-making in Oscar workflow tools, ensuring a member could easily reference & understand your decision (Flesch-Kincaid grade level).
Use correct templates for documenting decisions during case review.
Meet the appropriate turn-around times for clinical reviews.
Receive & review escalated reviews.
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.
Compliance with all applicable laws & regulations
Other duties as assigned

Requirements:

Board certification as an MD or DO
Licensed in FL or NC and/or active Interstate Medical Licensure Compact (IMLCC) or eligible to apply for IMLCC.
6+ years of clinical practice
1+ years of utilization review experience in a managed care plan (health care industry)

Bonus points:

Licensure in multiple Oscar states
BC in Cardiology, Radiation/Oncology, or Neurology
Experience with care management within the health insurance industry.
Willing & able to obtain additional state licensure as needed, with Oscar's support

This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here.

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.

Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, & experience. Full-time employees are eligible for benefits including: medical, dental, & vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life & disability insurance, & paid wellness time & reimbursements.

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Reasonable Accommodation: 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 (accommodations@hioscar.com) to make the need for an accommodation known.

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