Physician Reviewer - Utilization Management

📋 Description

• Determine medical appropriateness of inpatient, outpatient, and pharmacy services using guidelines.
• Review clinical information and apply evidence-based criteria in decision making.
• Document communications and decisions clearly for member accessibility.
• Use standard templates and meet turnaround times for reviews.
• Engage in peer-to-peer discussions with treating providers as needed.
• Support compliance with applicable laws and Oscar policies.

🎯 Requirements

• MD or DO board certification.
• Active license in FL, NC, AZ OR IMLC; IMLC member status required.
• 6+ years of clinical practice.
• Experience in utilization management in a managed care setting is a bonus.

🎁 Benefits

• Remote position with potential travel for meetings/events.
• Competitive base pay; 219,000 - 286,902 USD/year.
• Employee benefits, unlimited vacation, annual performance bonuses.
• Full-time benefits include medical, dental, vision, 401(k).