Senior Physician Reviewer, Utilization Management (Remote)

Oscar Health; United States; Remote; USD 219,000 - 287,000; Full time

Benefits offered by this job

Medical, dental, and vision benefits

11 paid holidays

401(k) plan participation

Life and disability insurance

Wellness time and reimbursements

Job summary

Oscar Health is hiring a Physician Reviewer to join our Utilization Management team. You will determine the medical appropriateness of inpatient, outpatient, and pharmacy services by reviewing clinical information and applying evidence-based guidelines.

This remote role in the United States offers work from home with occasional travel for meetings. Base pay ranges from $219,000 to $286,902 per year, plus benefits and performance bonuses.

Qualifications

• Board-certified MD or DO required.
• Licensed in FL, NC, AZ or hold active Interstate Medical Licensure Compact (IMLC).
• Minimum 6+ years of clinical practice.

Responsibilities

• Determine medical appropriateness of inpatient, outpatient, and pharmacy services by reviewing clinical information and applying evidence-based guidelines.
• Provide clinical determinations based on internal guidelines and evidence-based criteria.
• Document all communication and decisions clearly in Oscar workflow tools for traceability and readability.

Skills

Medical review

Evidence-based guidelines

Clinical documentation

Communication

Education

Board-certified MD/DO

Job description

Oscar Health is hiring a Physician Reviewer to join our Utilization Management team. You will determine the medical appropriateness of inpatient, outpatient, and pharmacy services by reviewing clinical information and applying evidence-based guidelines.

This remote role in the United States offers work from home with occasional travel for meetings. Base pay ranges from $219,000 to $286,902 per year, plus benefits and performance bonuses.