Physician Reviewer - Utilization Management

Oscar Health

🔍 Observed

$211K - $277K USD

Remote First seen 3 weeks ago Last seen 7 hours, 10 minutes ago Greenhouse

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Job Description

AI Summary

• Review medical appropriateness of inpatient, outpatient, and pharmacy services using clinical evidence and guidelines, with peer-to-peer provider discussions as needed • Requires MD/DO board certification, current FL or NC licensure (or IMLCC eligibility), 6+ years clinical practice, and 1+ years utilization review experience in managed care • Remote position based in Arizona, Florida, Georgia, or Texas with standard 8am-5pm hours plus one weekend call rotation every 16 weeks • Salary range of $211,200-$277,200 annually plus benefits, unlimited vacation, and performance bonuses • Bonus qualifications include multi-state licensure, cardiology/oncology/neurology board certification, and health insurance care management experience

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. #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

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

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 and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.

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

Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.

Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant’s 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.

California Residents: For information about our collection, use, and disclosure of applicants’ personal information as well as applicants’ rights over their personal information, please see our Privacy Policy.

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Job Information

Company:
Oscar Health
Location:
Remote
Work Location:
Remote
Experience Level:
Senior
Source:
Greenhouse
Status:
Active

Activity Score

65 /100

Likely Active (65)

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