Physician Reviewer - Utilization Management

Job details

Work model

Remote

Salary

$219,000 – $286,902 per year

Location

Remote

Hiring context

How this role compares at Oscar Health

Oscar Health has 289 live roles in MeritLog’s catalog across 13 job families, and 31 of them are in healthcare. 244 of those listings publish a pay range, a disclosure rate of 84%.

This role's posted range of $219,000 – $286,902 per year sits above 97% of the 226 other Oscar Health roles quoted over the same currency and period.

Counted across the job boards MeritLog tracks, at the time this page was served. Pay comparisons use only listings that publish a complete range in the same currency and period.

What the role asks for

Parsed by MeritLog from the employer’s own posting. The full description follows below.

Job description

Hi, we're Oscar. We're hiring a Physician Reviewer to join our Utilization Management team. Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves-one that behaves like a doctor in the family. About the role: You will determine the medical appropriateness of inpatient, outpatient, and pharmacy services by reviewing clinical information and applying evidence-based guidelines. Hours: 8am - 5pm in your local time zone Call rotation - 1 weekend every 16 weeks You will report into the Associate Medical Director, Utilization Management. Work Location: This is a remote position, open to candidates who reside in the United States. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events. #LI-Remote Pay Transparency: The base pay for this role is: $219,000- $ 286,902 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation, and annual performance bonuses. 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 • Other duties as assigned 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 Bonus points: • Licensure in multiple Oscar states • 1+ years of utilization review experience in a managed care plan (health care industry) • BC in Cardiology, Radiation/Oncology, or Neurology • Experience with care management within the health insurance industry. • Willing and able to obtain additional state licensure as needed, with Oscar's support This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here. At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives. Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements. Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts. Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant’s disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known. California Residents: For information about our collection, use, and disclosure of applicants’ personal information as well as applicants’ rights over their personal information, please see our Privacy Policy.