Physician Reviewer – Utilization Management

🔥 41 minutes ago

🌵 Arizona, Florida, +1 more states – Remote

🌵 Arizona – Remote 🐊 Florida – Remote 🌲 North Carolina – Remote

💵 $275k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Oscar Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2012

⚕️ Healthcare Insurance

🏥 Healthcare

💰 $355M Post-IPO Debt - Oscar Health on 2025-09

Healthcare Insurance • Healthcare

Oscar Health is a technology-driven health insurance company that provides individual, family, and small-group health plans in multiple U. S. states. Oscar combines traditional insurance underwriting with digital-first services — a consumer-facing app, 24/7 virtual urgent care, prescription delivery (including $3 meds in many plans), and dedicated Care Teams — and also operates Oscar Primary Care in some markets. The company emphasizes accessible, affordable, high-quality care and uses AI to improve member experience and care delivery. Insurance policies are underwritten by Oscar's state insurance subsidiaries and the company offers both HMO and other plan types across its markets.

📋 Description

• Determine the medical appropriateness of inpatient, outpatient, and pharmacy services by reviewing clinical information and applying evidence-based guidelines • Provide medical reviews meeting Oscar's quality parameters • Provide clinical determinations based on evidence-based criteria, internal guidelines, policies, and clinical acumen • Document communications and decision-making in Oscar workflow tools using correct templates • Meet turnaround times for clinical reviews • Receive and review escalated reviews • Conduct peer-to-peer discussions with treating providers to clarify clinical information and explain review outcomes • Provide feedback on alternate treatment based on medical necessity criteria and evidence-based research • Comply with applicable laws and regulations • Perform other duties as assigned • Report to the Associate Medical Director, Utilization Management • Participate in a call rotation of one weekend every 16 weeks

🎯 Requirements

• Board certification as an MD or DO • Licensed in Florida, North Carolina, or Arizona, or possess an active Interstate Medical Licensure Compact (IMLC) • 6+ years of clinical practice • Willing and able to obtain additional state licensure as needed, with Oscar's support • Licensure in multiple Oscar states is a bonus • 1+ years of utilization review experience in a managed care plan is a bonus • Board certification in Cardiology, Radiation/Oncology, or Neurology is a bonus • Experience with care management within the health insurance industry is a bonus

🏖️ Benefits

• Employee benefits • Oscar's unlimited vacation • Annual performance bonuses • Medical benefits • Dental benefits • Vision benefits • 11 paid holidays • Paid sick time • Paid parental leave • 401(k) plan participation • Life and disability insurance • Paid wellness time and reimbursements • Oscar's support to obtain additional state licensure as needed

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume