Physician Reviewer - Utilization Management

Responsibilities:

Provide 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.
Meet the appropriate turn-around times for clinical reviews.
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.
Compliance with all applicable laws and regulations
Other duties as assigned

Requirements:

Board certification as an MD or DO
Licensed in one of these states: FL, NC, AZ OR possess an active Interstate Medical Licensure Compact (IMLC).
6+ years of clinical practice

Bonus points:

Licensure in multiple Oscar states
1+ years of utilization review experience in a managed care plan (health care industry)
BC in Cardiology, Radiation/Oncology, or Neurology
Experience with care management within the health insurance industry.
Willing and able to obtain additional state licensure as needed, with Oscar's support