Associate Medical Director, Utilization Management

Oscar

Associate Medical Director determining medical appropriateness of services in Utilization Management team at Oscar Health. Leading a team of physicians to ensure efficient management and quality adherence.

Posted 5/12/2026full-timeRemote • Arizona, Florida, New York, North Carolina • 🇺🇸 United StatesLead💰 $240,120 - $315,157 per yearWebsite

About the role

Key responsibilities & impact

Determine the medical appropriateness of inpatient, outpatient, and pharmacy services by reviewing clinical information and applying evidence-based guidelines.
Influence departmental strategy, leading and overseeing a team of physicians ensuring efficient management and adherence to quality standards.
Report into the Senior Medical Director.
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.
Use correct templates for documenting decisions during case review.
Conduct timely peer-to-peer discussions with treating providers to clarify clinical information and to explain review outcome decisions.
Manage direct reports and oversee their performance.
Provide oversight to ensure the team meets turn-around times for clinical reviews.
Collaborate with other departments on Utilization Management Operations.
Lead key projects and drive initiatives to successful completion.

Requirements

What you’ll need

Board certification as an MD or DO with a current unrestricted license to practice medicine is required.
3+ years of clinical practice
2+ years of utilization review experience in a managed care plan (health care industry)

Benefits

Comp & perks

Performance bonus
401K with immediate vesting
18 PTO days per year
Additional bank of sick time
Floating holidays
CME days

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

clinical reviewevidence-based guidelinesutilization reviewclinical determinationscase review documentationpeer-to-peer discussionsperformance managementquality standards adherenceclinical acumen

Soft Skills

leadershipteam managementcollaborationcommunicationstrategic influenceoversightinitiative driving

Certifications

Board certification as MDBoard certification as DOunrestricted medical license