Physician Reviewer - Utilization Management

<p>Hi, we're Oscar. We're hiring a Physician Reviewer to join our Utilization Management team.</p> <p>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.</p> <p><strong>About the role:</strong></p> <p>You will determine the medical appropriateness of inpatient, outpatient, and pharmacy services by reviewing clinical information and applying evidence-based guidelines.</p> <p><strong>Hours:</strong> 8am - 5pm in your local time zone</p> <p>Call rotation - 1 weekend every 16 weeks</p> <p>You will report into the Associate Medical Director, Utilization Management.</p> <p><strong>Work Location: </strong>This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; or Texas. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events. #LI-Remote</p> <p><strong>Pay Transparency: </strong>The base pay for this role is: $211,200 - $ 277,200 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation, and annual performance bonuses.</p> <p><strong>Responsibilities:</strong></p> <ul> <li>Provide timely medical reviews that meet Oscar's stringent quality parameters.</li> <li>Provide clinical determinations based on evidence-based criteria and Oscar internal guidelines and policies, while utilizing clinical acumen.</li> <li>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).</li> <li>Use correct templates for documenting decisions during case review.</li> <li>Meet the appropriate turn-around times for clinical reviews.</li> <li>Receive and review escalated reviews.</li> <li>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.</li> <li>Compliance with all applicable laws and regulations</li> <li>Other duties as assigned</li> </ul> <p><strong>Requirements:</strong></p> <ul> <li>Board certification as an MD or DO</li> <li>Licensed in FL <strong>or </strong>NC <strong>and/or </strong>active Interstate Medical Licensure Compact (IMLCC) or eligible to apply for IMLCC.</li> <li>6+ years of clinical practice</li> <li>1+ years of utilization review experience in a managed care plan (health care industry)</li> </ul> <p><strong>Bonus points:</strong></p> <ul> <li>Licensure in multiple Oscar states</li> <li>BC in Cardiology, Radiation/Oncology, or Neurology</li> <li>Experience with care management within the health insurance industry.</li> <li>Willing and able to obtain additional state licensure as needed, with Oscar's support</li> </ul><div class="content-conclusion"><p><span style="font-weight: 400;">This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud</span><a href="http://hioscar.com/careers/recruitment-fraud-alert"><span style="font-weight: 400;"> </span><span style="font-weight: 400;">here</span></a><span style="font-weight: 400;">. </span></p> <p><span style="font-weight: 400;">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.</span></p> <p><strong>Pay Transparency: </strong><span style="font-weight: 400;">Final offer amounts, within the base pay set forth above, are determined by factors in ... (truncated, view full listing at source)