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About the Role
This role determines the medical appropriateness of inpatient, outpatient, and pharmacy services by reviewing clinical information and applying evidence-based guidelines. This role also influences departmental strategy, leading and overseeing a team of physicians ensuring efficient management and adherence to quality standards.
Responsibilities
- Provide timely 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.
- Receive and review escalated reviews.
- 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.
- Manage direct reports and oversee their performance.
- Provide oversight to ensure the team meets turn-around times for clinical reviews.
- Collaborate with other departments on Utilization Management Operations.
- Lead key projects and drive initiatives to successful completion.
- Other duties as assigned
- Compliance with all applicable laws and regulations.
Requirements
- Board certification as an MD or DO with a current unrestricted license to practice medicine is required.
- 3+ years of clinical practice
- 2+ years of utilization review experience in a managed care plan (health care industry)
- Licensure in multiple Oscar states
- Experience with care management within the health insurance industry.
- Willing and able to obtain additional state licensure as business needs, with Oscar's support
Location
- Remote
- Florida
- Arizona
- North Carolina
Work Type
- Remote
- Full-time
Experience Level
- Associate
Education Level
- MD or DO
Salary/Compensations
- $240,120 - $315,157 annually
Benefits
- Performance bonus
- 401K with immediate vesting
- Unlimited PTO
- Medical
- Dental
- Vision benefits
- 11 paid holidays
- Paid sick time
- Paid parental leave
- 401(k) plan participation
- Life and disability insurance
- Paid wellness time and reimbursements
About the Company
- 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.
Equal Opportunity
- 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.