Physician Reviewer - Utilization Management
Oscar Health · New York, New York
What the posting says
Each fact was read from this posting and checked:Statedin the posting, quotedConflictsposted two ways, both shownNot mentionedwe looked; it is not there
- Employment typeStated
- Full time
- Work arrangementStated
- Remote Solely
- ShiftStated
- day, weekend
Hours: 8am - 5pm in your local time zone
from the posting - ExperienceStated
- 5-10 years
- EducationStated
- ['postgraduate degree', 'professional certificate']
Not mentioned in this posting
We read the whole posting. These are not in it. Not a no: ask the recruiter, in your own words.
- PayNot mentioned
- The posting does not say
- Visa sponsorshipNot mentioned
- The posting does not say
Requirements, each with its sentence from the posting
These are the employer’s words. The index does not judge whether you meet them.
- MD or DOrequired
Board certification as an MD or DO
from the posting - State medical licensurerequired
Licensed in one of these states: FL, NC, AZ OR possess an active Interstate Medical Licensure Compact (IMLC).
from the posting - Clinical practicerequired
6+ years of clinical practice
from the posting - Utilization reviewpreferred
1+ years of utilization review experience in a managed care plan (health care industry)
from the posting - Board certification in specialtypreferred
BC in Cardiology, Radiation/Oncology, or Neurology
from the posting - Care managementpreferred
Experience with care management within the health insurance industry.
from the posting
Read the full posting as the employer wrote it
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 the United States. 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: $275,000 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation, and annual performance bonuses.
Responsibilities:
- Provide 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 one of these states: FL, NC, AZ OR possess an active Interstate Medical Licensure Compact (IMLC).
- 6+ years of clinical practice
Bonus points:
- Licensure in multiple Oscar states
- 1+ years of utilization review experience in a managed care plan (health care industry)
- 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.
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.
The posting text is reproduced as the employer wrote it; the index adds nothing to it.