Physician Reviewer – Utilization Management

Oscar

Physician Reviewer evaluating inpatient, outpatient, and pharmacy services at Oscar Health. Collaboratively ensuring adherence to evidence-based guidelines and internal protocols while conducting medical reviews remotely.

Posted 6/24/2026full-timeRemote • Arizona, Florida, North Carolina • 🇺🇸 United StatesMid-LevelSenior💰 $211,200 - $277,200 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
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
Meet the appropriate turn-around times for clinical reviews
Conduct timely peer-to-peer discussions with treating providers to clarify clinical information and explain review outcome decisions
Compliance with all applicable laws and regulations

Requirements

What you’ll need

Board certification as an MD or DO
Licensed in one of these states: FL, NC, AZ OR possess an active Interstate Medical Licensure Compact (IMLC)
6+ years of clinical practice

Benefits

Comp & perks

Health insurance
401(k) plan participation
Paid parental leave
Paid sick time
Paid time off
11 paid holidays
Unlimited vacation
Annual performance bonuses

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

clinical reviewevidence-based guidelinesmedical appropriateness determinationclinical acumendocumentationcase reviewpeer-to-peer discussions

Soft Skills

communicationdecision-makingtimelinessclarification

Certifications

MDDOInterstate Medical Licensure Compact (IMLC)