Physician Reviewer Utilization Management

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 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: $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 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 Oscars support