Part-Time Physician Reviewer, Utilization

  • Oscar
  • Remote
  • Jul 06, 2022
Physician Emergency Medicine Family Medicine General Surgery Internal Medicine Pediatrics

Job Description

Hi, we're Oscar. We're hiring a Part-time Physician Reviewer to join our Clinical Review 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. You will be a part of Oscar's clinical review team, including non-clinician processors, nurses, and other physicians working with Oscar providers and members.

This is a remote/work from home role but you must reside in one of these states: Arizona, California, Connecticut, Florida, Georgia, Illinois, Maryland, Massachusetts, Michigan, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, Tennessee, Texas, Utah, Virginia, or Washington. Note, this list of states is subject to change. #LI-Remote

Responsibilities:

  • Provide medical reviews that meet Oscar's stringent quality parameters.
  • Provide clinical determinations based on evidence-based criteria and Oscar internal guidelines, while using clinical expertise.
  • 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.
  • Review escalated reviews.
  • Conduct 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.

Basic Qualifications:

Licensure:

  • Board certification as an MD or DO with a current unrestricted license to practice medicine is required.
  • You must maintain necessary credentials to retain the position.

Experience:

  • 3+ years of clinical practice in one of the following fields: internal medicine, family medicine, general surgery, emergency medicine, pediatrics
  • 1+ years of utilization review experience in a managed care plan (health care industry)

Preferred Qualifications:

Licensure:

  • Licensure in multiple Oscar states (CA, AZ, MO and NC licensure is desirable); you should be willing to obtain additional state licenses, with Oscar's support.

Experience:

  • Experience with care management within the health insurance industry.

This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here

Life at Oscar: 

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.

We aim to make health care affordable and accessible for all, and apply this same vision to our perks and benefits, including: medical benefits, generous paid-time off, paid parental leave, retirement plans, company social events, stocked kitchens, wellness programs, and volunteer opportunities.

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.

To protect the health and safety of our employees, we require any employee conducting in-person work* to be fully vaccinated against COVID-19 by their start date. If you are unable to be vaccinated due to medical or protected religious reasons, please reach out to our Benefits team at accommodations@hioscar.com to submit an accommodations request.

*Note: In-person work includes: employees required to work from our offices, employees conducting sales work in the field and employees conducting at-home or in-person visits with members.