Physician Reviewer – Utilization Management

Job not on LinkedIn

🕒 5 days ago

🌵 Arizona, Florida, +1 more states – Remote

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

💵 $219k - $286.9k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

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Oscar Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2012

⚕️ Healthcare Insurance

🏥 Healthcare

🔥 Funding within the last year

💰 $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 • Make clinical determinations using evidence-based criteria, internal guidelines, policies, and clinical acumen • Document communications and decision-making in Oscar workflow tools using clear, accurate, member-understandable language • Use correct templates for documenting decisions during case review • Meet appropriate turnaround times for clinical reviews • Receive and review escalated reviews • Conduct timely 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

🏖️ Benefits

• Employee benefits • 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 insurance • Disability insurance • Paid wellness time • Wellness reimbursements • Support for obtaining additional state licensure as needed