[Hiring] Physician Reviewer - Utilization Management @Oscar Health

Role Description

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.

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.
• Occasional travel may be required for team meetings and 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, 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.

Qualifications

• 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.

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.