Medical Director, Utilization Management
Oscar Health
Hi, we're Oscar. We're hiring a Medical Director to join our CRT Physician Reviewer 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
This role supervises the physician team responsible for determining the medical appropriateness of inpatient, outpatient, and pharmacy services by reviewing clinical information and applying evidence-based guidelines. This role also collaborates with business units across the company to influence departmental strategy, and ensure efficient management and adherence to quality standards.
You will report to the Senior Medical Director, UM Operations.
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 Dr), 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, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, 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: $255,200 - $334,950 per year. You are also eligible for employee benefits, participation in Oscar’s unlimited vacation program, company equity grants and annual performance bonuses.
Responsibilities
- Oversee workforce management to ensure timely medical reviews that meet Oscar’s stringent quality parameters
- Partner with Senior Medical Director on the strategy & execution of a best-in-class Utilization Management program, in particular development of programs and initiatives that optimize the quality and cost of care
- Serve as the clinical liaison pertaining to Oscar’s Utilization Management program for clinical business operations, and other business units
- Manage direct reports, oversee their performance, and develop strategy for the professional development of physician reviewers
- Collaborate with other departments on Utilization Management Operations
- Lead key projects and drive initiatives to successful completion
- Compliance with all applicable laws and regulations
- Other duties as assigned
Qualifications
- Board certified or eligible MD or DO with a current unrestricted license to practice medicine in the US.
- 10+ years of experience in the healthcare industry
- 3+ years of clinical practice with specialization in one of the following fields: internal medicine, family medicine, general surgery, emergency medicine (other fields will be considered)
- 3+ years of utilization review experience in a managed care plan (health care industry)
- 3+ years of leadership experience as a people manager
Bonus Points
- Licensure in multiple Oscar states
- 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 Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant’s disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known.
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