Physician Reviewer - Utilization Management

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 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.

About the role:

You will determine the medical appropriateness of inpatient, outpatient, and pharmacy services by reviewing clinical information and 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 and company events.

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, and annual performance bonuses.

Responsibilities:

• Provide timely medical reviews that meet Oscar's stringent quality parameters.


• Provide clinical determinations based on evidence-based criteria and Oscar internal guidelines and policies, while utilizing clinical acumen.


• Clearly and accurately document all communication and decision-making in Oscar workflow tools, ensuring a member could easily reference and 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 and review escalated reviews.


• Conduct timely peer-to-peer discussions with treating providers to clarify clinical information and to explain review outcome decisions, including feedback on alternate treatment based on medical necessity criteria and evidence-based research.


• Compliance with all applicable laws and 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 and able to obtain additional state licensure as needed, with Oscar's support