About the role
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: $211,200 - $ 277,200 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.
Aplyr's read
Oscar Health is a tech-driven health insurer focused on enhancing member experience with digital tools and personalized services. Ideal for tech-savvy professionals in healthcare.
What's promising
- •Oscar Health leverages advanced technology to streamline healthcare services.
- •The company offers a dynamic work environment with roles in tech and healthcare.
- •Oscar Health is committed to improving healthcare accessibility and affordability.
What to watch
- •The health insurance market is highly competitive, posing challenges for growth.
- •Oscar Health's profitability remains uncertain amid ongoing investments in technology.
- •Regulatory changes in healthcare can impact Oscar Health's business operations.
Why Oscar Health
- •Oscar Health integrates technology with healthcare for a seamless member experience.
- •The company emphasizes personalized services through innovative digital tools.
- •Oscar Health's focus on tech-driven solutions differentiates it from traditional insurers.
Aplyr’s read is generated by AI from public sources. Was it useful?
About Oscar Health
Oscar is a health insurance company that leverages technology to provide affordable and accessible healthcare solutions. They focus on improving the healthcare experience for their members through innovative digital tools and personalized services.
