Physician Reviewer - Utilization & Care Management

Remotedxb; Dubai; On-site; AED 775,615 - 1,017,994; Full time

Benefits offered by this job

Competitive base pay

Annual performance bonuses

Medical, dental, and vision benefits

Unlimited vacation and wellness time

401(k) plan & parental leave

Job summary

Oscar is seeking a medical reviewer to assess inpatient, outpatient, and pharmacy services using evidence-based guidelines and to provide timely reviews within strict quality parameters. The role involves documenting all communications and engaging in peer-to-peer discussions with treating providers to clarify information and outcomes.

Candidates should have an MD/DO, active licenses in US states (or IMLC), and 6+ years of clinical practice.

Qualifications

• Board certification as an MD or DO.
• Active medical license in FL, NC, or AZ, or IMLC.
• 6+ years of clinical practice experience.

Responsibilities

• Determine the medical appropriateness of inpatient, outpatient, and pharmacy services by reviewing clinical information and applying evidence-based guidelines.
• Provide timely medical reviews that meet quality parameters and turnaround times.
• Document communications and decisions clearly in workflow tools.
• Conduct peer-to-peer discussions with treating providers to clarify information and explain decisions.
• Receive and review escalated reviews and ensure regulatory compliance.

Skills

Medical review

Clinical judgment

Evidence-based guidelines

Regulatory compliance

Peer discussions

Education

MD/DO

Job description

Oscar is seeking a medical reviewer to assess inpatient, outpatient, and pharmacy services using evidence-based guidelines and to provide timely reviews within strict quality parameters. The role involves documenting all communications and engaging in peer-to-peer discussions with treating providers to clarify information and outcomes.

Candidates should have an MD/DO, active licenses in US states (or IMLC), and 6+ years of clinical practice.