Remote Associate Medical Director - Utilization Management

name; New York (NY); On-site; USD 240,120 - 315,157; Full time

Benefits offered by this job

Performance bonus

401K with immediate vesting

Unlimited PTO

Job summary

Oscar is hiring an Associate Medical Director to join the Utilization Management Team. This role determines medical appropriateness of inpatient, outpatient, and pharmacy services, reviewing clinical information against guidelines, and leading a team of physicians to ensure quality and efficiency.

You will report to the Senior Medical Director and work remotely with potential travel for meetings and events. The position offers a base salary and comprehensive benefits.

Qualifications

• Board certification as an MD or DO with a current unrestricted license to practice medicine is required.
• 3+ years of clinical practice
• 2+ years of utilization review experience in a managed care plan

Responsibilities

• Provide timely medical reviews that meet Oscar's stringent quality parameters.
• Provide clinical determinations based on evidence-based criteria and internal guidelines.
• Document all communication and decisions clearly in Oscar workflow tools.
• Use correct templates for documenting decisions during case review.
• Receive and review escalated reviews.
• Conduct timely peer-to-peer discussions with treating providers to clarify information and explain decisions.
• Manage direct reports and oversee their performance.
• Ensure the team meets turnaround times for clinical reviews.
• Collaborate with other departments on Utilization Management Operations.
• Lead key projects and drive initiatives to successful completion.
• Other duties as assigned

Skills

Clinical judgment

Leadership

Education

MD or DO with unrestricted license

Tools

Oscar workflow tools

Job description

Oscar is hiring an Associate Medical Director to join the Utilization Management Team. This role determines medical appropriateness of inpatient, outpatient, and pharmacy services, reviewing clinical information against guidelines, and leading a team of physicians to ensure quality and efficiency.

You will report to the Senior Medical Director and work remotely with potential travel for meetings and events. The position offers a base salary and comprehensive benefits.