Physician Reviewer - Utilization Management

United States·New Yorkmid

OperationsOtherManagementHealthcarePhysician

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Quick Summary

Key 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,

Requirements Summary

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.

Technical Tools

OperationsOtherManagementHealthcarePhysician

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

~1 min read

You will determine the medical appropriateness of inpatient, outpatient, and pharmacy services by reviewing clinical information and applying evidence-based guidelines.

Responsibilities

~1 min read

→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

~1 min read

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)

Nice to Have

~2 min read

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.

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