Physician Reviewer (Part -Time) - Utilization Management
About The Position
Oscar is seeking a Physician Reviewer to join their Utilization Management Team. This role involves determining the medical appropriateness of inpatient, outpatient, and pharmacy services by reviewing clinical information and applying evidence-based guidelines. The position requires a minimum commitment of 20-25 hours per week, with a call rotation including 16 weekend hours per month. This is a remote position open to candidates residing in the United States, though occasional travel may be required for team meetings and company events. The base pay for this role is $140-$145 per hour.
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
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What This Job Offers
Job Type
Part-time
Career Level
Mid Level
Education Level
Ph.D. or professional degree
