Physician Reviewer Utilization Management at Oscar Health

Hi were Oscar. Were 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 ourselvesone 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 zoneCall rotation - 1 weekend every 16 weeksYou 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-RemotePay Transparency: The base pay for this role is: $211200 - $ 277200 per year. You are also eligible for employee benefits participation in Oscars unlimited vacation and annual performance bonuses.Responsibilities:Provide timely medical reviews that meet Oscars 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 regulationsOther duties as assignedRequirements:Board certification as an MD or DOLicensed in FL or NC and/or active Interstate Medical Licensure Compact (IMLCC) or eligible to apply for IMLCC.6 years of clinical practice1 years of utilization review experience in a managed care plan (health care industry)Bonus points:Licensure in multiple Oscar statesBC in Cardiology Radiation/Oncology or NeurologyExperience with care management within the health insurance industry.Willing and able to obtain additional state licensure as needed with Oscars supportThis 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. Were 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 applicants disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team () 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 . Key Skills Facilities Management,Banking,Content Writing,Customer Support,Fun,Airlines Employment Type : Full-Time Experience: years Vacancy: 1