Behavioral Health Utilization Management Medical Director
Hi, we're Oscar. We're hiring a Behavioral Health UM Medical Director to join our Member Strategy & Ops team in a part-time capacity.
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 is a part-time role, providing about 10 hours of coverage 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 departments to affect 2 primary pillars:
- Regulatory / Accreditation - Participate in the implementation, management, evaluation, and oversight of the behavioral health aspects of Oscar's utilization management, case management and quality improvement programs according to state, federal and accrediting body standards. This includes representing Oscar to external regulatory entities.
- Plan performance - Work with all partners to improve clinical, financial and operational performance related to behavioral health services of the plan.
The services performed by this role are central to both the compliance and accreditation of Oscar's utilization management program.
You will report to the Chief Medical Officer, Insurance.
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 base pay for this role is: $122.23 - $160.42 per hour. You are also eligible for employee benefits, and monthly vacation accrual at a rate of 10 days per year.
- 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.
- 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.
- 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
This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here.
At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives..
Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience.
Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.
Oscar applicants are considered solely based on their qualifications, without regard to applicant’s disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (firstname.lastname@example.org) to make the need for an accommodation known.