[Hiring] Behavioral Health Physician Reviewer @Oscar Health

Role Description

We're hiring a Behavioral Health Physician Reviewer to join our Utilization Management team. The Behavioral Health Medical Director oversees behavioral health services across Oscar / +Oscar plans by collaborating closely with internal teams and external vendors. This role ensures that utilization management, case management, and quality improvement programs meet all state, federal, and accreditation standards. The Behavioral Health Medical Director drives clinical, financial, and operational performance to continuously optimize behavioral health outcomes across the plan.

You will report into the Medical Director, Utilization Management.

Work Location:

• This position is fully remote and open to candidates residing in the U.S., excluding Alaska; Delaware; Hawaii; Louisiana; Montana; North Dakota; Oklahoma; West Virginia; Wyoming; and U.S. Territories.
• Daily work is completed from your home office, with occasional travel required for team meetings and company events.

Pay Transparency:

• The base pay for this role is: $130-$145 per hour.

Responsibilities

• Participate in the implementation, supervision, evaluation, and oversight of the behavioral health aspects of Oscar's utilization management program.
• Develop a strong working relationship with key regulators and accrediting bodies.
• Represent Oscar externally in behavioral health clinical matters and audits where applicable.
• Provide clinical determinations based on evidence-based criteria and Oscar internal guidelines and policies.
• Conduct timely evaluations of escalated cases, including initial denials, peer-to-peers, and first-level appeals, within required turnaround times.
• Clearly and accurately document all communication and decision-making in Oscar workflow tools.
• Maintain oversight for quality improvement and medical management services pertaining to behavioral health at Oscar.
• Support oversight of behavioral health vendors, including quality assurance of delegated functions, when applicable.
• Compliance with all applicable laws and regulations.
• Other duties as assigned.

Qualifications

• 3+ years of clinical practice as a psychiatrist.
• MD or DO with a current unrestricted license to practice medicine in the US, and willing to obtain additional state licenses with Oscar's support.
• Board certified in Psychiatry.
• Medical licensure in Florida, or IMLCC-eligible.

Requirements

• 1+ years of behavioral health managed care, utilization review or equivalent experience (bonus points).
• Licensure in multiple additional Oscar states preferred but not required (AZ, NC are highly desirable).
• Experience with behavioral health care management.
• Experience in a startup: understanding the pace and culture.

Benefits

• 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.