Physician Reviewer - Utilization ManagementNew$219K–$287K

Hi, we're Oscar. We're hiring a Physician Reviewer to join our Utilization Management team.

What you'll do

• Provide medical reviews that meet Oscar's stringent quality parameters.

• Provide clinical determinations based on evidence-based criteria and Oscar: internal guidelines and policies, while utilizing clinical acumen.

• Clearly and accurately 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.

• Receive and review escalated reviews.

What they're looking for

• Conduct timely 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.
• Compliance with all applicable laws and regulations
• Other duties as assigned
• Board certification as an MD or DO