Oscar Health
Behavioral Health Physician Reviewer (Part-Time)
About this role
Hi, we're Oscar. We're hiring a Behavioral Health Physician Reviewer to join our Utilization Management team. Oscar is the first health insurance company built around a full stack technology platform and a relentless 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: The Behavioral Health Medical Director oversees behavioral health services across Oscar / +Oscar plans by collaborating closely with internal teams and external vendors. This role ensures that utilization management, case management, and quality improvement programs meet all state, federal, and accreditation standards. The Behavioral Health Medical Director drives clinical, financial, and operational performance to continuously optimize behavioral health outcomes across the plan. You will report into the Medical Director, Utilization Management. Work Location: This position is fully remote and open to candidates residing in the U.S., excluding Alaska; Delaware; Hawaii; Louisiana; Montana; North Dakota; Oklahoma; West Virginia; Wyoming; and U.S. Territories. Daily work is completed from your home office, with occasional travel required for team meetings and company events. #LI-Remote Pay Transparency: The base pay for this role is: $130-$145 per hour.
Responsibilities
- Participate in the implementation, supervision, evaluation, and oversight of the behavioral health aspects of Oscar's utilization management program, including developing a strong working relationship with key regulators and accrediting bodies, and represent Oscar externally in behavioral health clinical matters and audits where applicable.
- Provide clinical determinations based on evidence-based criteria and Oscar internal guidelines and policies, while utilizing your clinical acumen
- Conduct timely evaluations of escalated cases, including initial denials, peer-to-peers (including giving feedback on alternate treatment based on medical necessity criteria and evidence-based research) and first-level appeals, within required turnaround times. Clearly and accurately document all communication and decision-making in Oscar workflow tools, ensuring a member could easily reference and understand decisions.
- Maintain oversight for quality improvement and medical management services pertaining to behavioral health at Oscar, including participation in relevant committees and sub-committees of the Quality Improvement (QI) program.
- Support oversight of behavioral health vendors, including quality assurance of delegated functions, when applicable.
- Compliance with all applicable laws and regulations.
- Other duties as assigned. Requirements: