Physician Reviewer - Utilization Management

Who you are

You are a qualified physician with experience in utilization management and a strong understanding of clinical guidelines. You have a keen eye for detail and are adept at reviewing clinical information to determine the appropriateness of medical services. Your communication skills are excellent, allowing you to document decisions clearly and effectively for members to understand. You are comfortable working in a remote environment and can manage your time effectively to meet deadlines. You are committed to providing high-quality medical reviews that align with Oscar's standards and policies.

Desirable

Experience in a health insurance setting or familiarity with evidence-based guidelines would be beneficial. You may have a background in clinical practice that enhances your ability to make informed decisions regarding patient care. A collaborative mindset is essential, as you will work closely with the Associate Medical Director and other team members.

What you'll do

In this role, you will be responsible for conducting timely medical reviews that meet Oscar's stringent quality parameters. You will assess the medical necessity of inpatient, outpatient, and pharmacy services by reviewing clinical information and applying evidence-based criteria. Your role will involve documenting all communication and decision-making processes in Oscar's workflow tools, ensuring clarity and transparency for members. You will participate in a call rotation, providing support during weekends every 16 weeks. Your contributions will directly impact the quality of care provided to Oscar's members, ensuring they receive appropriate services based on their medical needs.

What we offer

Oscar offers a competitive salary range of $211,200 to $277,200 per year, along with comprehensive employee benefits. You will have access to unlimited vacation and annual performance bonuses, promoting a healthy work-life balance. The company values its employees and fosters a supportive environment where you can thrive professionally. As a remote position, you will have the flexibility to work from home while occasionally traveling for team meetings and company events. Oscar is dedicated to creating a health insurance experience that prioritizes member care and satisfaction.