Physician Reviewer, Utilization Management

Summary

Join Oscar's Utilization Management team as a Physician Reviewer! This role involves determining the medical appropriateness of various services by reviewing clinical information and applying evidence-based guidelines. You'll report to the Medical Director and work remotely or in one of our offices (NYC, Tempe, or Los Angeles), depending on your location. The position requires board certification as an MD or DO, significant clinical experience, and utilization review experience. Competitive salary ($211,200 - $277,200), benefits (medical, dental, vision, paid time off, 401k, life and disability insurance), and bonuses are offered. This is a blended work culture where everyone feels connected, regardless of work type or location.

Requirements

• Board certification as an MD or DO with a current unrestricted license to practice medicine is required
• 6+ years of clinical practice
• 1+ years of utilization review experience in a managed care plan (health care industry)
• Reside in one of the specified states

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

Preferred Qualifications

• Licensure in multiple Oscar states
• Board Certified in Cardiology or Neurology
• Experience with care management within the health insurance industry
• Willing and able to obtain additional state licensure as business needs, with Oscar’s support

Benefits

• Employee benefits
• Participation in Oscar’s unlimited vacation program
• Annual performance bonuses
• Medical, dental, and vision benefits
• 11 paid holidays
• Paid sick time
• Paid parental leave
• 401(k) plan participation
• Life and disability insurance
• Paid wellness time and reimbursements