Clinical Physician Reviewer - Utilization Management (Part Time)
About this role
About the Role Oscar is hiring a part-time Physician Reviewer to join our Utilization Management team. You will determine the medical appropriateness of inpatient, outpatient, and pharmacy services by reviewing clinical information and applying evidence-based guidelines. What You'll Do
- 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.
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