Remote Physician Reviewer, Utilization Management

Oscar Health Insurance; Northern (KY); Hybrid; 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

Paid wellness time and reimbursements

Job summary

Oscar Health Insurance seeks an MD/DO to determine the medical appropriateness of inpatient, outpatient, and pharmacy services by reviewing clinical information and applying evidence-based guidelines.

This remote role (US-based) reports to the Associate Medical Director, Utilization Management, with travel for team meetings as needed. Base pay ranges from $219,000 to $286,902 per year, plus benefits.

Qualifications

• Board-certified MD or DO.
• Licensed in FL, NC, or AZ, or active IMLC license.
• 6+ years of clinical practice.
• Multiple Oscar state licensure.
• 1+ year of utilization review in managed care.
• Board certification in Cardiology, Radiation/Oncology, or Neurology.
• Willing to obtain additional state licensure with Oscar's support.

Responsibilities

• Provide timely medical reviews meeting Oscar's quality parameters.
• Provide clinical determinations based on evidence-based criteria and internal guidelines; use clinical acumen.
• Document all communications and decisions clearly in Oscar workflow tools for easy reference.
• Meet required turn-around times for clinical reviews.
• Receive and review escalated reviews.
• Conduct timely peer-to-peer discussions with treating providers to explain decisions and alternatives.
• Ensure compliance with applicable laws and regulations.
• Other duties as assigned.

Skills

Board certification

Medical license

Utilization review

Care management

Specialties: Cardiology

Specialties: Neurology

Interstate licensure

Experience with guidelines

Education

MD/DO

Job description

Oscar Health Insurance seeks an MD/DO to determine the medical appropriateness of inpatient, outpatient, and pharmacy services by reviewing clinical information and applying evidence-based guidelines.

This remote role (US-based) reports to the Associate Medical Director, Utilization Management, with travel for team meetings as needed. Base pay ranges from $219,000 to $286,902 per year, plus benefits.