Physician Reviewer

Responsibilities

• Determine the medical appropriateness of inpatient, outpatient, and pharmacy services by reviewing clinical information and applying evidence-based guidelines.
• Provide timely medical reviews that meet stringent quality parameters and meet appropriate turnaround times.
• Document all communication and decision-making clearly and accurately in workflow tools.
• Conduct peer-to-peer discussions with treating providers to clarify clinical information and explain review outcome decisions.
• Receive and review escalated reviews and ensure compliance with all applicable laws and regulations.

Requirements

• Board certification as an MD or DO.
• Active medical license in FL, NC, or AZ, or possession of an active Interstate Medical Licensure Compact (IMLC).
• 6+ years of clinical practice experience.

Preferred Qualifications

• 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.
• Licensure in multiple Oscar states.
• Willingness to obtain additional state licensure as needed.

Benefits

• Competitive base pay ranging from $211,200 - $277,200 per year.
• Annual performance bonuses.
• Comprehensive medical, dental, and vision benefits.
• Unlimited vacation and paid wellness time.
• 401(k) plan participation and paid parental leave.

About the Company

Oscar is a health insurance company built around a full-stack technology platform and a relentless focus on serving members. Founded in 2012, Oscar aims to create a healthcare experience that behaves like a doctor in the family, utilizing technology to improve care and accessibility.