Physician Reviewer – Utilization Management

Job not on LinkedIn

🔥 12 hours 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

WebsiteLinkedInAll Job Openings

51 - 200 employees

💼 Consulting

🏗️ Construction

🏥 Healthcare

💰 $140M Private Equity Round on 2020-12

Consulting • Construction • Healthcare

Oscar is a world-class specialist STEM recruitment agency that provides industry-leading talent solutions. The company operates across six brands, connecting top talent with companies in various sectors including technology, construction, life sciences, and renewable energy. With offices across the globe, Oscar is recognized as a top-five company to work for and is committed to delivering excellence in staffing services.

📋 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