Physician Reviewer - Utilization Management
New
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OscarHealth Insurance
This is a remote position, open to candidates who reside in the United States., 8am - 5pm in your local time zoneFull-TimeSenior
Salary$219,000- $ 286,902 per year
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Job Details
- Experience
- 6+ years of clinical practice
Requirements
- Board certification as an MD or DO
- Active license in FL, NC, or AZ, or possession of an active Interstate Medical Licensure Compact (IMLC) credential
- 6+ years of clinical practice
- Ability to work 8am - 5pm in your local time zone
- Ability to participate in call rotation: 1 weekend every 16 weeks
- Willingness to obtain additional state licensure as needed
- 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 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.
- 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 explain review outcome decisions.
- Maintain compliance with all applicable laws and regulations.
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