Hi, we’re Oscar. We’re hiring a Behavioral Health Utilization Management Medical Director to join our Member Strategy & Ops team.

Oscar is the first health insurance company built around a full stack technology platform and a 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

This role is part-time (averaging 10 hours per week).

You will maintain oversight of behavioral health services within plans supported by Oscar / +Oscar. You will work both externally with vendors and internally with teams.

The services performed by you in this role are central to both the compliance and accreditation of Oscar’s utilization management program.

You will report to the VP & Medical Director, Member Programs.

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

The pay for this role is: $122.23 - $160.42 per hour.

Responsibilities

• Participate in the implementation, supervision, evaluation, and oversight of the behavioral health aspects of Oscar’s utilization management program.
• Develop a working relationship with important 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 on 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

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.

Bonus Points

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