Behavioral Health Physician Reviewer

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.

Responsibilities

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.

• 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

• 3+ years of clinical practice as a psychiatrist.

• MD or DO with a current unrestricted license to practice medicine in the US, and willing to obtain additional state licenses with Oscar's support.

• License and Certification:

• Board certified in Psychiatry Medical licensure in Florida, or IMLCC-eligible

Bonus points:

• 1+ years of behavioral health managed care, utilization review or equivalent experience.

• Licensure in multiple additional Oscar states preferred but not required (AZ, NC are highly desirable).

• Experience with behavioral health care management. Experience in a startup: understanding the pace and culture.

This is an authentic Oscar Health job opportunity.

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.

Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.

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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