Associate Medical Director, Utilization Management

📋 Description

• Assess the medical suitability of inpatient, outpatient, and pharmacy services by analyzing clinical data and applying evidence-based guidelines.

• Shape departmental strategy by leading and managing a team of physicians to ensure effective oversight and compliance with quality standards.

• Report directly to the Senior Medical Director.

• Deliver prompt medical reviews that adhere to Oscar's rigorous quality criteria.

• Make clinical determinations grounded in evidence-based standards and Oscar's internal policies, utilizing clinical expertise.

• Document all communications and decision-making processes accurately within Oscar's workflow tools.

• Employ appropriate templates for recording decisions made during case reviews.

• Engage in timely peer-to-peer discussions with treating providers to clarify clinical details and explain the outcomes of reviews.

• Supervise direct reports and evaluate their performance.

• Ensure the team consistently meets turnaround times for clinical evaluations.

• Collaborate with other departments on Utilization Management Operations.

• Lead significant projects and drive initiatives to successful completion.

⛳️ Requirements

• Board certification as an MD or DO with an active, unrestricted medical license is mandatory.

• A minimum of 3 years of clinical practice experience.

• At least 2 years of experience in utilization review within a managed care setting (healthcare industry).

🏝️ Benefits

• Performance bonus.

• 401K with immediate vesting.

• 18 PTO days annually.

• Additional sick time bank.

• Floating holidays.

• CME days.