Physician Reviewer – Utilization Management

This is a fully remote position, open to applicants in United States.

📋 Description

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

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

• Make clinical determinations based on evidence-based criteria and internal policies at Oscar.

• Accurately document communication and decision-making in Oscar's workflow tools.

• Utilize appropriate templates for documenting decisions during the case review process.

• Adhere to established turnaround times for clinical reviews.

• Receive and evaluate escalated reviews.

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

• Provide feedback on alternative treatment options based on medical necessity criteria and evidence-based research.

• Ensure compliance with relevant laws and regulations.

• Perform additional duties as assigned.

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

⛳️ Requirements

• Board certification as a Medical Doctor (MD) or Doctor of Osteopathy (DO).

• Licensed in Florida, North Carolina, or Arizona, or hold an active Interstate Medical Licensure Compact (IMLC).

• Over 6 years of clinical practice experience.

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

🏝️ Benefits

• Comprehensive employee benefits.

• Unlimited vacation policy.

• Annual performance bonuses.

• Medical coverage.

• Dental coverage.

• Vision coverage.

• 11 paid holidays annually.

• Paid sick leave.

• Paid parental leave.

• Participation in a 401(k) plan.

• Life insurance coverage.

• Disability insurance.

• Paid wellness time and reimbursements.

• Opportunities for occasional travel for team meetings and company events.