1 день назад
Physician Reviewer - Utilization Management
219 000 - 286 902$
Вакансия из Hirify Global, списка международных tech-компанийДля мэтча и отклика нужен Plus
Мэтч & Сопровод
Для мэтча с этой вакансией нужен Plus
Описание вакансии
Текст:
TL;DR
Physician Reviewer - Utilization Management (Health Insurance): Determining the medical appropriateness of inpatient, outpatient, and pharmacy services by reviewing clinical information and applying evidence-based guidelines, with an accent on clinical documentation, quality parameters, and medical necessity decisions. Focus on conducting escalated and peer-to-peer reviews, explaining treatment decisions to providers, and meeting clinical review turnaround times.
Location: Remote within the United States; work hours are 8am–5pm in the local time zone, with occasional travel for team meetings and company events.
Salary: $219,000–$286,902 per year, plus employee benefits and annual performance bonuses.
Company
is a health insurance company built around a full-stack technology platform and focused on serving its members.
What you will do
- Determine the medical appropriateness of inpatient, outpatient, and pharmacy services.
- Review clinical information and apply evidence-based criteria, internal guidelines, and policies.
- Document clinical determinations and communications accurately in workflow tools using appropriate templates.
- Complete clinical reviews within required turnaround times and handle escalated reviews.
- Conduct peer-to-peer discussions with treating providers, clarify clinical information, and explain review outcomes.
- Provide feedback on alternative treatments based on medical necessity criteria and evidence-based research.
Requirements
- Board certification as an MD or DO.
- Active medical licensure in Florida, North Carolina, or Arizona, or an active Interstate Medical Licensure Compact license.
- 6+ years of clinical practice.
- Ability to comply with applicable laws, regulations, quality parameters, and review turnaround times.
Nice to have
- Licensure in multiple Oscar states.
- At least 1 year of utilization review experience in a managed care plan.
- Board certification in Cardiology, Radiation Oncology, or Neurology.
- Experience with care management in the health insurance industry.
- Willingness and ability to obtain additional state licenses with Oscar’s support.
Culture & Benefits
- Full-time employee benefits include medical, dental, and vision coverage.
- 11 paid holidays, paid sick time, paid parental leave, and paid wellness time.
- 401(k) plan participation, life and disability insurance, and wellness reimbursements.
- Unlimited vacation and annual performance bonuses.
- One weekend of call duty every 16 weeks.
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