Physician Reviewer – Utilization Management

Job overview

The Physician Reviewer – Utilization Management role is remote for candidates residing in the United States. Compensation is $219,000–$286,902 per year. The reviewer joins Oscar Health’s Utilization Management team, supporting the company’s member-focused health insurance services. The physician evaluates clinical information and applies evidence-based criteria to determine the medical appropriateness of services. Clear documentation, timely reviews, and peer-to-peer discussions help ensure consistent decisions and explain outcomes to members and treating providers.

What you'll do

• Review inpatient, outpatient, and pharmacy services for medical appropriateness
• apply evidence-based criteria and internal guidelines
• document communications and decisions clearly in workflow tools
• use appropriate case-review templates
• meet review turnaround times
• receive escalated reviews
• conduct timely peer-to-peer discussions with treating providers
• comply with applicable laws and regulations.

What we're looking for

Skills & competencies

physician reviewer

utilization management

remote us

oscar health

medical necessity review

clinical guidelines

peer-to-peer reviews

board-certified md or do

$219k–$286,902/year

weekend call rotation

Work arrangement

• Weekend coverage required

Benefits & perks

• Medical, dental, and vision
• unlimited vacation
• annual performance bonuses
• paid holidays and sick time
• paid parental leave
• 401(k)
• life and disability insurance
• wellness time and reimbursements

Why this role

Remote within the United States; hours are 8 a.m.–5 p.m. in the employee’s local time zone. Call rotation includes one weekend every 16 weeks; occasional travel may be required.

About the employer

Oscar Health is hiring for this role. Industry: Direct Health and Medical Insurance Carriers. Sector: 52.