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 analyzing clinical data and utilizing evidence-based guidelines.

• Conduct medical reviews that align with Oscar's quality standards.

• Make clinical decisions based on evidence-based criteria, internal protocols, policies, and clinical expertise.

• Record communications and decision-making processes in Oscar's workflow tools using clear, accurate, and member-friendly language.

• Utilize appropriate templates for documenting decisions during case evaluations.

• Adhere to specified turnaround times for clinical assessments.

• Handle and review escalated cases.

• Engage in timely peer-to-peer discussions with treating providers to clarify clinical details and communicate review outcomes.

• Offer feedback on alternative treatments based on medical necessity criteria and research grounded in evidence.

• Ensure compliance with relevant laws and regulations.

• Perform additional duties as required.

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

• Participate in a call rotation, with one weekend duty every 16 weeks.

⛳️ Requirements

• Board certification as a Medical Doctor (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).

• Over 6 years of clinical experience.

• Willing and able to acquire additional state licensure as necessary, with assistance from Oscar.

🏝️ Benefits

• Employee benefits.

• Unlimited vacation.

• Annual performance bonuses.

• Medical benefits.

• Dental benefits.

• Vision benefits.

• 11 paid holidays.

• Paid sick leave.

• Paid parental leave.

• Participation in a 401(k) plan.

• Life insurance.

• Disability insurance.

• Paid wellness time.

• Wellness reimbursements.

• Support for obtaining additional state licensure as necessary.