Medical Director, Behavioral Health Utilization Management

Hi, we're Oscar. We are hiring a Medical Director to support our Behavioral Health Utilization Management team, on a part-time basis.

About the role:

We are working to bring a new level of service to utilization review and ensure Oscar members receive access to appropriate care.

You will determine the medical appropriateness of behavioral health services by reviewing clinical information and applying evidence-based guidelines. You will also participate in quality improvement and medical management services pertaining to behavioral health at Oscar, including behavioral health care management activities when applicable.

This is a part-time, remote/work from home role. You must reside in one of the following states: Arizona, California, Connecticut, Florida, Georgia, Illinois, Maryland, Massachusetts, Michigan, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, Tennessee, Texas, Utah, Virginia, or Washington. Note, this list of states is subject to change. #LI-Remote

You will report to Oscar's Vice President and Medical Director of Member Programs.

Responsibilities:

• Provide clinical determinations based on evidence-based criteria and Oscar internal policies, while using your clinical expertise.
• Document all communication and decision-making in Oscar workflow tools, ensuring a member could easily reference and understand your decision
• Use correct templates for documenting decisions during case review.
• Meet the appropriate turn-around times for clinical reviews.
• Review escalated reviews (either initial denial or internal / first level appeal).
• Conduct peer-to-peer discussions with treating providers to clarify clinical information and explain review outcome decisions, including feedback on alternate treatment based on medical necessity criteria and evidence-based research.
• Participate in quality improvement and medical management services pertaining to behavioral health at Oscar, including behavioral health care management activities and activities related to overseeing vendors of behavioral health services, when applicable.

Basic Qualifications:

• MD or DO with a current unrestricted license to practice medicine in the US. You should be willing to obtain additional state licenses, with Oscar's support.
• Board certified in psychiatry
• 3+ years of clinical practice as a psychiatrist

Preferred Qualifications:

• 1+ years of behavioral health utilization review experience
• Licensure in multiple Oscar states (AZ and CA are desirable)
• Experience with behavioral health care management
• Experience in a startup: understanding the pace and culture

This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here. 

Life at Oscar: 

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.

We aim to make health care affordable and accessible for all, and apply this same vision to our perks and benefits, including: medical benefits, generous paid-time off, paid parental leave, retirement plans, company social events, stocked kitchens, wellness programs, and volunteer opportunities.

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.

To protect the health and safety of our employees, we require any employee conducting in-person work* to be fully vaccinated against COVID-19 by their start date. If you are unable to be vaccinated due to medical or protected religious reasons, please reach out to our Benefits team at accommodations@hioscar.com to submit an accommodations request.

*Note: In-person work includes: employees required to work from our offices, employees conducting sales work in the field and employees conducting at-home or in-person visits with members.