Physician Reviewer - Utilization Management

📋 Description

• Determine medical appropriateness of inpatient, outpatient, and pharmacy services by reviewing clinical information and applying evidence-based guidelines.
• Review clinical data and apply evidence-based guidelines.
• Document decisions clearly in Oscar workflow tools for easy member reference.
• Meet turnaround times and conduct peer-to-peer discussions with treating providers.
• Remote role; hours 8am-5pm local time; one weekend every 16 weeks.
• Occasional travel may be required for team meetings and events.

🎯 Requirements

• Board certification as an MD or DO.
• Licensed in FL, NC, or AZ; or active Interstate Medical Licensure Compact IMLC.
• 6+ years of clinical practice.
• Bonus points: Licensure in multiple Oscar states.
• Experience with care management in health insurance.
• Willing to obtain additional state licensure with Oscar's support.

🎁 Benefits

• Medical, dental, and vision benefits.
• Unlimited vacation.
• Annual performance bonus.
• 401(k) plan participation.
• Life and disability insurance.
• Paid holidays and wellness time.