Physician Reviewer – Utilization Management
Oscar Health
Posted: 10/20/2026
Primary Care Sports Medicine Physician
OrthoVirginia
Posted: 10/20/2026
Primary Care Physician – Adult Medicine
One Medical
Posted: 10/20/2026Primary Care Physician – Adult Medicine
One Medical
Posted: 10/20/2026Primary Care Physician – Adult Medicine
One Medical
Posted: 10/20/2026
LPN, Family Medicine
Matrix Providers
Posted: 10/20/2026
Physician
Marathon Health
Posted: 10/20/2026E
Patient Services Representative – Crossridge Internal Medicine
Easyservice Italia
Posted: 10/20/2026
Licensed Practical Nurse – Pediatrics, General Internal Medicine
Ohio State University Physicians
Posted: 10/20/2026
Experienced Medical Scribe – Family Medicine
Scribe LLC
Posted: 10/20/2026
Physician Liaison
IVIRMA Italia
Posted: 10/20/2026
Physician Liaison
Reproductive Medicine Associates (RMA Network)
Posted: 10/20/2026
Board Certified Physician Reviewer – Infectious Disease
Dane Street
Posted: 10/20/2026
Physician – ADHD Diagnosis and Treatment
Receptive Inc.
Posted: 10/20/2026Physician – ADHD Diagnosis and Treatment
Receptive Inc.
Posted: 10/20/2026Physician – ADHD Diagnosis and Treatment
Receptive Inc.
Posted: 10/20/2026Physician – ADHD Diagnosis and Treatment
Receptive Inc.
Posted: 10/20/2026
Physician Advisor Lead
HURC Healthcare Solutions
Posted: 10/19/2026
Physician
GoHealth Urgent Care
Posted: 10/19/2026
Physician – Trauma Surgery
University of Arkansas System
Posted: 10/19/2026Physician Reviewer – Utilization Management
Oscar HealthPosted 10/20/2026full-timeRemote • United StatesMid-LevelSenior💰 $219,000 - $286,902 per yearWebsite
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in clinical review processes, applying evidence-based guidelines and internal policies to determine the appropriateness of medical services. Strong communication skills are essential for conducting peer-to-peer discussions and clarifying clinical information with providers.
Highest-signal resume keywords
Board Certification As An MD Or DOLicensed In Florida, North Carolina, Or Arizona6+ Years Of Clinical PracticeEvidence-Based Clinical DeterminationsCompliance With Applicable Laws And Regulations
About the role
Key responsibilities & impact- Determine the medical appropriateness of inpatient, outpatient, and pharmacy services by reviewing clinical information and applying evidence-based guidelines
- Provide medical reviews meeting Oscar's quality parameters
- Provide clinical determinations using evidence-based criteria, internal guidelines, policies, and clinical acumen
- Document communications and decision-making in Oscar workflow tools
- Use correct templates for documenting decisions during case review
- Meet turnaround times for clinical reviews
- Receive and review escalated reviews
- Conduct peer-to-peer discussions with treating providers
- Clarify clinical information and explain review outcome decisions, including alternate-treatment feedback
- Comply with applicable laws and regulations
- Report to the Associate Medical Director, Utilization Management
- Participate in a call rotation of one weekend every 16 weeks
- Perform other duties as assigned
Requirements
What you’ll need- Board certification as an MD or DO
- Licensed in Florida, North Carolina, or Arizona, or possess an active Interstate Medical Licensure Compact (IMLC)
- 6+ years of clinical practice
- Willing and able to obtain additional state licensure as needed, with Oscar's support
Benefits
Comp & perks- Employee benefits
- Unlimited vacation
- Annual performance bonuses
- Medical, dental, and vision benefits
- 11 paid holidays
- Paid sick time
- Paid parental leave
- 401(k) plan participation
- Life and disability insurance
- Paid wellness time and reimbursements
- Occasional travel for team meetings and company events
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Clinical ReviewEvidence-Based GuidelinesMedical Appropriateness DeterminationDocumentation In Workflow ToolsClinical AcumenCase Review TemplatesTurnaround Time ManagementPeer-To-Peer DiscussionsAlternate-Treatment Feedback
Soft Skills
Communication SkillsDecision-MakingCollaboration
Tools & Technologies
Oscar Workflow Tools
Certifications & Qualifications
Board Certification As An MD Or DOActive Interstate Medical Licensure Compact (IMLC)
Industry Keywords
Utilization ManagementInpatient ServicesOutpatient ServicesPharmacy ServicesClinical Information