Physician Reviewer - Utilization Management
O
OscarHealth insurance
This is a remote position, open to candidates who reside in the United States., 8am - 5pm in your local time zoneFull-TimeSenior
SalaryThe base pay for this role is: $219,000- $ 286,902 per year.
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Job Details
- Experience
- 6+ years of clinical practice
Requirements
- Hold board certification as an MD or DO.
- Be licensed in FL, NC, or AZ, or possess an active Interstate Medical Licensure Compact (IMLC).
- Have 6+ years of clinical practice.
- Participate in the stated work schedule: 8am–5pm in your local time zone.
- Participate in a call rotation of one weekend every 16 weeks.
Responsibilities
- Review inpatient, outpatient, and pharmacy services to determine medical appropriateness.
- Make clinical determinations using evidence-based criteria and Oscar internal guidelines and policies.
- Document communications and decisions accurately in Oscar workflow tools using the correct templates.
- Meet appropriate turnaround times for clinical reviews.
- Receive and review escalated cases.
- Conduct timely peer-to-peer discussions with treating providers to clarify clinical information and explain review outcomes.
- Provide feedback on alternate treatment based on medical necessity criteria and evidence-based research.
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