Physician Reviewer - Utilization Management (Part Time)
About The Position
Oscar is hiring a part-time Physician Reviewer to join their Utilization Management team. Oscar is a health insurance company built on a technology platform with a focus on serving its members. The Physician Reviewer will determine the medical appropriateness of inpatient, outpatient, and pharmacy services by reviewing clinical information and applying evidence-based guidelines. The role requires a minimum commitment of 20 hours per week, with hours from 8 am to 5 pm in the local time zone. There is a call rotation of one weekend every 16 weeks. The position reports to the Associate Medical Director, Utilization Management. This is a remote position open to candidates residing in the United States, though occasional travel may be required for meetings and events.
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
Nice To Haves
- 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
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
Benefits
- medical
- dental
- vision benefits
- 11 paid holidays
- paid sick time
- paid parental leave
- 401(k) plan participation
- life and disability insurance
- paid wellness time and reimbursements
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Part-time
Career Level
Mid Level
