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Associate Medical Director, Utilization Management
Oscar
- Nashville, Tennessee, United States
- Nashville, Tennessee, United States
Über
Determine the medical appropriateness of inpatient, outpatient, and pharmacy services by reviewing clinical information and applying evidence-based guidelines. Influence departmental strategy, leading and overseeing a team of physicians ensuring efficient management and adherence to quality standards. Report into the Senior Medical Director. Provide timely medical reviews that meet Oscar's stringent quality parameters. Provide clinical determinations based on evidence-based criteria and Oscar internal guidelines and policies, while utilizing clinical acumen. Clearly and accurately document all communication and decision-making in Oscar workflow tools. Use correct templates for documenting decisions during case review. Conduct timely peer-to-peer discussions with treating providers to clarify clinical information and to explain review outcome decisions. Manage direct reports and oversee their performance. Provide oversight to ensure the team meets turn-around times for clinical reviews. Collaborate with other departments on Utilization Management Operations. Lead key projects and drive initiatives to successful completion. Requirements:
Board certification as an MD or DO with a current unrestricted license to practice medicine is required. 3+ years of clinical practice 2+ years of utilization review experience in a managed care plan (health care industry) Benefits:
Performance bonus 401K with immediate vesting 18 PTO days per year Additional bank of sick time Floating holidays CME days
Sprachkenntnisse
- English
Hinweis für Nutzer
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