Physician Reviewer (Utilization Management)
New
O
OscarHealth Insurance
Open to candidates who reside in the United States, 8am - 5pm in your local time zonePart-TimeMiddle
Salary140 - 145 USD per hour
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Job Details
- Experience
- 6+ years of clinical practice
Requirements
- Board certification as an MD or DO.
- 6+ years of clinical practice.
- Licensed in one of these states: FL, NC, AZ.
- Possess an active Interstate Medical Licensure Compact (IMLC).
- Availability for 20-25 hours per week.
- Ability to work 8am-5pm in your local time zone.
- Ability to support a call rotation of 16 weekend hours per month.
Responsibilities
- Provide timely medical reviews meeting quality parameters.
- Issue clinical determinations based on evidence-based criteria and internal guidelines.
- Document communication and decision-making accurately in workflow tools.
- Adhere to turnaround time requirements for clinical reviews.
- Conduct peer-to-peer discussions with treating providers regarding clinical information and outcome explanations.
- Review escalated cases.
- Ensure compliance with all applicable laws and regulations.
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