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Salary: USD 219,000 - 286,902 / annual
Oscar Health is seeking a Physician Reviewer to join its Utilization Management team. In this role, you will determine the medical appropriateness of inpatient, outpatient, and pharmacy services by reviewing clinical information and applying evidence-based guidelines.
You will be responsible for providing medical reviews that meet Oscar's quality standards, making clinical determinations based on evidence-based criteria and internal guidelines while leveraging your clinical expertise. You will document all communication and decision-making clearly and accurately in Oscar's workflow tools, ensuring members can easily understand your decisions. You will use correct templates for case documentation and meet appropriate turnaround times for clinical reviews.
The role includes receiving and reviewing escalated cases, conducting timely peer-to-peer discussions with treating providers to clarify clinical information and explain review outcomes, and providing feedback on alternate treatments based on medical necessity criteria and evidence-based research. You will ensure compliance with all applicable laws and regulations.
Work hours are 8am–5pm in your local time zone, with a call rotation requiring coverage one weekend every 16 weeks. You will report to the Associate Medical Director of Utilization Management. This is a fully remote position open to US-based candidates; occasional travel may be required for team meetings and company events.
Oscar Health is a technology-driven health insurance company founded in 2012, built around a full-stack platform with a focus on member service.
Requirements:
- Board certification as an MD or DO
- Active medical license in Florida, North Carolina, Arizona, OR active Interstate Medical Licensure Compact (IMLC) credential
- 6+ years of clinical practice
Bonus qualifications:
- Licensure in multiple Oscar states
- 1+ years of utilization review experience in a managed care plan
- Board certification in Cardiology, Radiation Oncology, or Neurology
- Experience with care management in the health insurance industry
- Willingness and ability to obtain additional state licensure as needed
