Physician Reviewer

Responsibilities

• Provide medical reviews that meet Oscar's stringent quality parameters
• Provide clinical determinations based on evidence-based criteria and internal guidelines
• Document all communication and decision-making clearly in workflow tools
• Meet 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 explain outcomes
• Ensure compliance with all applicable laws and regulations

Requirements

• Board certification as an MD or DO
• Licensed in FL, NC, AZ or possess an active IMLC
• 6+ years of clinical practice

Preferred Qualifications

• Licensure in multiple Oscar states
• 1+ years of utilization review experience in a managed care plan
• Board Certification in Cardiology, Radiation/Oncology, or Neurology
• Experience with care management within the health insurance industry
• Ability to obtain additional state licensure as needed

About the Company

Oscar is a health insurance company built around a full stack technology platform and a relentless focus on serving members, behaving like a doctor in the family.