Physician Reviewer, Pharmacy Utilization Management (Part -Time)

Hi, we're Oscar. We're hiring a Physician Reviewer (Part time) to join our Pharmacy Utilization Management team.

Oscar is the first health insurance company built around a full stack technology platform and a focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.

About the role

Determines the medical appropriateness of inpatient, outpatient, and pharmacy services by reviewing clinical information and applying evidence-based guidelines. Part of Oscar’s clinical review team, including non-clinician processors, nurses, and other physicians interacting with Oscar providers and members. 

You will report to the Medical Director, Utilization Management.

Work Location: 

Oscar is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture and our mission. 

If you live within commutable distance to our New York City office ( in Hudson Square), our Tempe office (off the 101 at University Ave), or our Los Angeles office (in Marina Del Rey), you will be expected to come into the office at least two days each week. Otherwise, this is a remote / work-from-home role. 

You must reside in one of the following states: Alabama, Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Kentucky, Maryland, Massachusetts, Michigan, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, Tennessee, Texas, Utah, Virginia, Washington, or Washington, D.C. Note, this list of states is subject to change. #LI-Remote

Pay Transparency:

The base pay for this role is: $111.54- $146.39 per hour.

Responsibilities

• Provide timely 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. 

• Demonstrate the highest level of professionalism, accountability, and service in your interactions with Oscar teammates, providers, and members.

 

Qualifications

Licensure:

• Board certification as an MD or DO with a current unrestricted license to practice medicine is required.

• Reviewers must maintain necessary credentials to retain the position. 

Experience:

• 3+ years of clinical practice in one of the following fields: internal medicine, family medicine, general surgery, emergency medicine, pediatrics 

• 1+ years of utilization review experience in a managed care plan (health care industry)

 

Bonus Points

Licensure:

• Licensure in multiple Oscar states (CA, AZ, NC, OR, AR, TX and MO licensure is highly desirable); you should be willing to obtain additional state licenses, with Oscar's support.

Experience:

• Experience with care management within the health insurance industry.

This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here. 

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..

Pay Transparency: 

Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience.

Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.

Reasonable Acco