Physician Reviewer – Utilization Management

This is a fully remote position, open to applicants in Arizona, +2 more states.

📋 Description

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

• Ensure medical reviews align with Oscar's quality standards.

• Make clinical determinations based on evidence-based criteria, internal guidelines, policies, and clinical expertise.

• Record communications and decision-making processes in Oscar's workflow tools.

• Utilize appropriate templates for documenting decisions during case evaluations.

• Adhere to turnaround times for clinical reviews.

• Handle and evaluate escalated reviews.

• Facilitate peer-to-peer discussions with treating healthcare providers.

• Clarify clinical information and articulate review outcome decisions, including feedback on alternative treatments.

• Adhere to all applicable laws and regulations.

• Report directly to the Associate Medical Director, Utilization Management.

• Participate in a call rotation, which includes one weekend every 16 weeks.

• Perform additional duties as assigned.

⛳️ Requirements

• Board certification as a Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO).

• Must be licensed in Florida, North Carolina, or Arizona, or hold an active Interstate Medical Licensure Compact (IMLC) credential.

• A minimum of 6 years of clinical practice experience.

• Willingness and ability to obtain additional state licensure as necessary, with support from Oscar.

🏝️ Benefits

• Comprehensive employee benefits package.

• Unlimited vacation policy.

• Annual performance-based bonuses.

• Medical, dental, and vision insurance coverage.

• 11 paid holidays each year.

• Paid sick leave.

• Paid parental leave.

• Participation in a 401(k) retirement plan.

• Life and disability insurance options.

• Paid wellness time and reimbursement programs.

• Occasional travel for team meetings and corporate events.