Behavioral Health Physician Reviewer (Part-Time)Active$270K–$302K
The opportunity
Hi, we're Oscar. We're hiring a Behavioral Health Physician Reviewer to join our Utilization Management team.
What you'll do
Participate in the implementation, supervision, evaluation, and oversight of: the behavioral health aspects of Oscar's utilization management program, including developing a strong working relationship with key regulators and accrediting bodies, and represent Oscar externally in behavioral health clinical matters and audits where applicable.
Provide clinical determinations based on evidence-based criteria and Oscar: internal guidelines and policies, while utilizing your clinical acumen
Conduct timely evaluations of escalated cases, including initial denials,: peer-to-peers (including giving feedback on alternate treatment based on medical necessity criteria and evidence-based research) and first-level appeals, within required turnaround times. Clearly and accurately document all communication and decision-making in Oscar workflow tools, ensuring a member could easily reference and understand decisions.
Maintain oversight for quality improvement and medical management services: pertaining to behavioral health at Oscar, including participation in relevant committees and sub-committees of the Quality Improvement (QI) program.
Support oversight of behavioral health vendors, including quality assurance: of delegated functions, when applicable.
Compliance with all applicable laws and regulations.
What they're looking for
- Other duties as assigned.
- + years of clinical practice as a psychiatrist.
- MD or DO with a current unrestricted license to practice medicine in the US,: and willing to obtain additional state licenses with Oscar's support.
- License and Certification:
