Part-time Physician Reviewer

  • Oscar
  • Remote
  • Mar 27, 2021
Physician Emergency Medicine Family Medicine General Surgery Internal Medicine

Job Description

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

Oscar is a technology-driven, consumer-focused health insurance startup founded in 2012 and headquartered in New York City. Our goal is to make health insurance simple, transparent, and human. We need your help to do so.

About the role:

As a Physician Reviewer for Utilization Management at Oscar, you will be one of the physician reviewers who determines the medical appropriateness of inpatient, outpatient, and pharmacy services by reviewing clinical information and applying evidence-based guidelines. You will be a part of our clinical review team, including non-clinician processors, nurses, and other physicians. You will report to the Senior Medical Director for Utilization Management. In this role, you may interact with Oscar providers and members. This is a part-time role that will be remote.

Responsibilities:

  • Provide clinical determinations based on evidence-based criteria and Oscar internal guidelines and policies, while utilizing your 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 (either initial denial or internal / first level appeal).
  • 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. 
  • Demonstrate the highest level of professionalism, accountability, and service in your interactions with Oscar teammates, providers, and members

Requirements:

  • Licensure: Board certification as an MD or DO with a current unrestricted license to practice medicine is required. Licensure in multiple Oscar states is preferred but not required (CA, AZ, MI, MO and NC licensure is highly desirable); you should be willing to obtain additional state licenses, with Oscar's support. Reviewers must maintain necessary credentials to retain the position.
  • 3+ years of clinical practice in one of the following fields: internal medicine, family medicine, general surgery, emergency medicine
  • 1+ years of utilization review experience in a managed care plan (health care industry)
  • Your home office is located in one of the following states: AZ, CA, FL, GA, IL, MD, MA, MI, NJ, NY, OH, PA, TN, TX, UT, VA, WA.

Bonus points:

  • Experience with care management within the health insurance industry
  • Able to multi-task and manage tasks to completion on a timely basis and in an organized fashion
  • Comfortable with technology; willing and able to learn new software tools 
  • Clear written and spoken communication
  • Flexible mindset: we are a fast-moving and evolving company

Life at Oscar: 

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.

We encourage our members to care for their whole selves, and we encourage our employees to do the same with comprehensive medical benefits, generous paid-time off, paid parental leave, retirement plans, company social events, stocked kitchens, wellness programs, and volunteer opportunities.

Reasonable Accommodation:

Oscar applicants are considered solely based on their qualifications, without regard to applicant’s disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known.

Pay Transparency Policy:

Oscar ensures that you won't be discharged or discriminated against based on whether you've inquired about, discussed, or disclosed your pay. Read the full policy here.