Physician Reviewer - Utilization Management jobs in United States
cer-icon
Apply on Employer Site
company-logo

Oscar Health · 1 month ago

Physician Reviewer - Utilization Management

positionUnited States
timeFull-time
remoteRemote
senioritySenior Level
money$211K/yr - $277K/yr
date6+ years exp

Oscar is a health insurance company built around a full stack technology platform focused on serving its members. The Physician Reviewer will determine the medical appropriateness of services by reviewing clinical information and applying evidence-based guidelines.

Health CareHealth InsuranceInsuranceInsurTech
check
H1B Sponsor Likelynote

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
Compliance with all applicable laws and regulations
Other duties as assigned

Qualification

Board certification as MDDOLicensed in FLNCUtilization review experienceClinical practice experienceClinical acumenEvidence-based guidelinesCommunication skills

Required

Board certification as an MD or DO
Licensed in FL or NC and/or active Interstate Medical Licensure Compact (IMLCC) or eligible to apply for IMLCC
6+ years of clinical practice
1+ years of utilization review experience in a managed care plan (health care industry)

Preferred

Licensure in multiple Oscar states
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

Benefits

Medical, dental, and vision benefits
11 paid holidays
Paid sick time
Paid parental leave
401(k) plan participation
Life and disability insurance
Paid wellness time and reimbursements

Company

Oscar Health

twittertwittertwitter
Glassdoor3.3
company-logo
Oscar is a health insurance company that offers individual and family plans, medicare advantages, and small group products.
dateFounded in 2012
location
New York, New York, USA
people-size1001-5000 employees
web-link
http://www.hioscar.com

H1B Sponsorship

Oscar Health has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (19)
2024 (24)
2023 (22)
2022 (36)
2021 (13)

Funding

Current Stage
Public Company
Total Funding
$1.99B
Key Investors
Tiger Global ManagementAlphabetFounders Fund
2025-09-16Post Ipo Debt· $355M
2021-03-03IPO
2020-12-17Private Equity· $140M

Leadership Team

leader-logo
Mark Bertolini
Chief Executive Officer
linkedin
leader-logo
Steven B. Kelmar
Executive Vice President & COS
linkedin

Recent News

BioSpace
Oscar Health, Inc. 2025 Fourth Quarter and Full Year Earnings Conference Call
2026-01-15
Sherwood News
Insurers rise as House tees up ACA extension vote
2026-01-09
Benzinga.com
This Jared Kushner-Backed Insurance Stock Is Starting To Fizzle Out: Momentum Score Drops
2025-12-30
Company data provided by crunchbase