Job Description
Hi, we're Oscar. We're hiring a Behavioral Health Utilization Management Medical Director to join our Member Strategy & Ops team.
Oscar is the first health insurance company built around a full stack technology platform and a 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 behavioral health services by reviewing clinical information and applying evidence-based guidelines. This role is required to meet Oscar's contractual services to Cigna as part of our C+O partnership, for which Oscar is delegated for behavioral health utilization management services. The services performed by this role are central to both the compliance and accreditation of Oscar's utilization management program.
You will report to the VP Medical Director, Member Programs. This is a remote / work-from-home role. You must reside in one of the following states: Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Maryland, Massachusetts, Michigan, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, Tennessee, Texas, Utah, Virginia, Washington, or Washington, D.C. Note, this list of states is subject to change. #LI-Remote
The potential base pay for this role is: $254,232 - $333,680
Responsibilities
- Provide clinical determinations based on evidence-based criteria and Oscar internal policies, while using your clinical knowledge.
- Document all communication and decision-making in Oscar workflow tools, ensuring a member could easily reference and understand your decision
- Use correct templates for documenting decisions during case review.
- Meet the appropriate turn-around times for clinical reviews.
- Review escalated reviews (either initial denial or internal / first level appeal).
- Conduct peer-to-peer discussions with treating providers to clarify clinical information and explain review outcome decisions, including feedback on alternate treatment based on medical necessity criteria and evidence-based research.
- Participate in quality improvement and medical management services on behavioral health at Oscar, including behavioral health care management activities and activities related to overseeing vendors of behavioral health services, when applicable.
Qualifications
- 3+ years of clinical practice as a Psychiatrist
- MD or DO with a current unrestricted license to practice medicine in the US.
- Board certified in Psychiatry
Bonus Points
- 1+ years of behavioral health utilization review experience or equivalent
- Experience with behavioral health care management
- Experience in a startup: understanding the pace and culture
- Licensure in multiple Oscar states (AZ and CA are highly desirable); you should be willing to obtain additional state licenses, 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 are determined by multiple factors including geographic location and candidate experience, and may vary from the pay range amounts listed above.
You may be eligible for additional compensation and benefits including: company equity, performance bonuses, sales commissions, medical, dental, and vision benefits, paid-time off, sick time, paid parental leave, retirement plans, life and disability insurance, and wellness reimbursements.
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.
Health care is broken; we're trying to fix it. The Oscar team is focused on utilizing technology, design and data to humanize health care. We're a group of technology and health care professionals who looked at the current state of the US health care system, got frustrated by the horrible consumer experience, and decided to do something big about it. Backed by a renowned set of investors and advisors, we’ve set out to revolutionize health care.