Behavioral Health Physician Reviewer (Part-Time)

Oscar Health•New York, NY

4d•$130 - $145•Remote

About The Position

Oscar is hiring a Behavioral Health Physician Reviewer to join their Utilization Management team. Oscar is a health insurance company that utilizes a full stack technology platform and focuses on serving its members. The Behavioral Health Medical Director oversees behavioral health services across Oscar / +Oscar plans by collaborating closely with internal teams and external vendors. This role ensures that utilization management, case management, and quality improvement programs meet all state, federal, and accreditation standards. The Behavioral Health Medical Director drives clinical, financial, and operational performance to continuously optimize behavioral health outcomes across the plan. This position is fully remote and open to candidates residing in the U.S., excluding Alaska; Delaware; Hawaii; Louisiana; Montana; North Dakota; Oklahoma; West Virginia; Wyoming; and U.S. Territories. Daily work is completed from your home office, with occasional travel required for team meetings and company events.

Requirements

3+ years of clinical practice as a psychiatrist.
MD or DO with a current unrestricted license to practice medicine in the US, and willing to obtain additional state licenses with Oscar's support.
Board certified in Psychiatry
Medical licensure in Florida, or IMLCC-eligible

Nice To Haves

1+ years of behavioral health managed care, utilization review or equivalent experience.
Licensure in multiple additional Oscar states preferred but not required (AZ, NC are highly desirable).
Experience with behavioral health care management.
Experience in a startup: understanding the pace and culture.

Responsibilities

Participate in the implementation, supervision, evaluation, and oversight of the behavioral health aspects of Oscar's utilization management program, including developing a strong working relationship with key regulators and accrediting bodies, and represent Oscar externally in behavioral health clinical matters and audits where applicable.
Provide clinical determinations based on evidence-based criteria and Oscar internal guidelines and policies, while utilizing your clinical acumen.
Conduct timely evaluations of escalated cases, including initial denials, peer-to-peers (including giving feedback on alternate treatment based on medical necessity criteria and evidence-based research) and first-level appeals, within required turnaround times. Clearly and accurately document all communication and decision-making in Oscar workflow tools, ensuring a member could easily reference and understand decisions.
Maintain oversight for quality improvement and medical management services pertaining to behavioral health at Oscar, including participation in relevant committees and sub-committees of the Quality Improvement (QI) program.
Support oversight of behavioral health vendors, including quality assurance of delegated functions, when applicable.
Compliance with all applicable laws and regulations.
Other duties as assigned.