Physician Reviewer - Utilization Management
O
Oscar HealthHealth Insurance
This is a remote position, open to candidates who reside in the United States., 8am - 5pm in your local time zoneFull-TimeSenior
Salary211,200 - 277,200 USD per year
Apply NowOpens the employer's application page
Job Details
- Experience
- 6+ years of clinical practice
Requirements
- Board certification as an MD or DO
- Licensed in one of these states: FL, NC, AZ OR possess an active Interstate Medical Licensure Compact (IMLC).
- 6+ years of clinical practice
Responsibilities
- Provide timely medical reviews that meet Oscar's stringent quality parameters.
- Provide clinical determinations based on evidence-based criteria and Oscar internal guidelines and policies, while utilizing clinical acumen.
- Clearly and accurately document all communication and decision-making in Oscar workflow tools, ensuring a member could easily reference and understand your decision (Flesch-Kincaid grade level).
- Use correct templates for documenting decisions during case review.
- Meet the appropriate turn-around times for clinical reviews.
- Receive and review escalated reviews.
- Conduct timely peer-to-peer discussions with treating providers to clarify clinical information and to explain review outcome decisions, including feedback on alternate treatment based on medical necessity criteria and evidence-based research.
- Compliance with all applicable laws and regulations
View Full Description & ApplyYou'll be redirected to the employer's site
