Remote Physician Reviewer - Utilization & Guidelines

Oscar Health; Phoenix (AZ); Remote; USD 219,000 - 287,000; Full time

Benefits offered by this job

Medical, dental, and vision benefits

11 paid holidays

Paid sick time

Paid parental leave

401(k) plan participation

Life and disability insurance

Wellness time and reimbursements

Unlimited vacation

Job summary

Oscar Health seeks a Physician Reviewer to join the Utilization Management team in a remote US-based role. You will determine the medical appropriateness of services and document decisions using evidence-based guidelines and Oscar workflows.

Responsibilities include timely clinical reviews, peer discussions, and adherence to laws and internal policies. The role offers strong benefits and a competitive base salary with performance bonuses.

Qualifications

• Board certification as an MD and valid medical licensure.
• 6+ years of clinical practice with health plan exposure ideal.
• Willing to obtain additional state licensure with company support.

Responsibilities

• Assess medical necessity for inpatient, outpatient, and pharmacy services.
• Apply evidence-based criteria and internal guidelines.
• Document decisions clearly in Oscar workflow tools and maintain compliance.

Skills

Clinical decision making

Medical knowledge

Evidence-based review

Documentation accuracy

Education

MD board certified

Active medical license (AZ/FL/NC etc.)

IMLC licensure

Job description

Oscar Health seeks a Physician Reviewer to join the Utilization Management team in a remote US-based role. You will determine the medical appropriateness of services and document decisions using evidence-based guidelines and Oscar workflows.

Responsibilities include timely clinical reviews, peer discussions, and adherence to laws and internal policies. The role offers strong benefits and a competitive base salary with performance bonuses.