Physician Reviewer - Utilization Management
New
O
Oscar HealthHealth Insurance
This is a remote position, open to candidates who reside in the United States., 8am - 5pm in your local time zone.Part-TimeMiddle
Salary130 - 145 USD per hour
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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.
- Possess an active Interstate Medical Licensure Compact (IMLC).
- 6+ years of clinical practice.
- Ability to work a minimum commitment of 20 hours per week.
- Available for call rotation of 1 weekend every 16 weeks.
- Licensure in multiple Oscar states (preferred).
- 1+ years of utilization review experience in a managed care plan (preferred).
- Board Certification in Cardiology, Radiation/Oncology, or Neurology (preferred).
- Experience with care management within the health insurance industry (preferred).
Responsibilities
- Provide timely medical reviews that meet Oscar's quality parameters.
- Provide clinical determinations based on evidence-based criteria and internal guidelines.
- Document all communication and decision-making accurately in workflow tools.
- Use correct templates for documenting decisions during case review.
- Meet 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 explain outcomes.
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