Full-Time
Behavioral Health Utilization Management Medical Director
Posted on 3/4/2023
Health insurance company
Compensation Overview
$122.23 - $160.42Hourly
Senior
Remote
- MD or DO with a current unrestricted license to practice medicine in the US
- Board certified in Psychiatry
- 3+ years of clinical practice as a psychiatrist
- Participate in the implementation, management, evaluation, and oversight of the behavioral health aspects of Oscar's utilization management program
- Develop a working relationship with 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 policies, while using your clinical knowledge
- Clearly document all communication and decision-making in Oscar workflow tools, ensuring a member could easily reference and understand your decision
- 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
- 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
- Demonstrate professionalism, accountability, and service in your interactions with Oscar teammates, providers, and members
- 1+ years of behavioral health managed care, utilization review or equivalent experience
- Licensure in multiple Oscar states (AZ and CA are highly desirable)
- 1+ years of experience with behavioral health care management
- 1+ years of experience in a startup: understanding the pace and culture
Oscar Health’s mission is to make high-quality health insurance accessible and affordable for everyone. The company is a software driven health insurance company that offers medical plans, medicare advantages, and small group products.
Company Stage
N/A
Total Funding
$1.6B
Headquarters
New York, New York
Founded
2012
6 month growth
↑ 2%1 year growth
↑ 10%2 year growth
↑ 19%Benefits
Health insurance - That’s a given. Employees and their families receive incredible health insurance.
Financial benefits - A penny saved....we’re talking about a 401K plan, health savings accounts, and more.
Well @ Oscar - We care about your wellness with fitness classes and access to mental health support.
Work-Life Balance - We offer multiple time-off options, wellness days, and 10+ weeks of parental leave.
Learning & Development - We offer everything from mentorship to management training.