Oscar Health: Physician Reviewer - Utilization Management — Remote

About Oscar Health

Oscar Health is a health-insurance business built around a technology platform and member services. Its recruitment board also describes Oscar Medical Group activities in virtual health assessments and virtual care. Those notices reflect distinct parts of the wider operation: insurance products and member administration alongside clinical services. Technology, insurance operations and care delivery consequently appear in different roles on the board, with the employing team determining the service and professional responsibilities of an individual position.

The position and its setting

Oscar Health lists Physician Reviewer - Utilization Management in Remote, under reference 8303962. The details below separate the work described by the employer from essential conditions, preferred experience and practical preparation advice.

• Department: Clinical
• Employer listing date: 20 October 2026

Responsibilities and work described

• Determine the medical appropriateness of inpatient, outpatient, and pharmacy services by reviewing clinical information and applying evidence-based guidelines
• Hours: 8am - 5pm in your local time zone
• Call rotation - 1 weekend every 16 weeks
• Report into the Associate Medical Director, Utilization Management
• Work: Location: This is a remote position, open to candidates who reside in the United States
• While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events. #LI-Remote
• Pay Transparency: The base pay for this role is: $219,000- $ 286,902 per year
• You are also eligible for employee benefits, participation in Oscar's unlimited vacation, and annual performance bonuses
• Delivery: medical reviews that meet Oscar's stringent quality parameters
• Delivery: 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, ensuring a member could easily reference and understand your decision (Flesch-Kincaid grade level)
• Use correct templates for documenting decisions during case review
• Meet the appropriate turn-around times for clinical reviews
• Receive and review escalated reviews
• Research / execution: timely peer-to-peer discussions with treating providers to clarify clinical information and to explain review outcome decisions, including feedback on alternate treatment based on medical necessity criteria and evidence-based research
• Compliance with all applicable laws and regulations

Essential requirements and candidate background

• Board certification as an MD or DO
• Licensed in one of these states: FL, NC, AZ OR possess an active Interstate Medical Licensure Compact (IMLC)
• 6+ years of clinical practice

Experience and professional background

• 1+ years of utilization review experience in a managed care plan (health care industry)
• Experience: care management within the health insurance industry

Preferred experience and additional strengths

• Licensure in multiple Oscar states
• BC in Cardiology, Radiation/Oncology, or Neurology
• Willing and able to obtain additional state licensure as needed, with Oscar's support
• This is an authentic Oscar Health job opportunity
• Pay Transparency: 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
• Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts
• California Residents: For information about our collection, use, and disclosure of applicants’ personal information as well as applicants’ rights over their personal information, please see our Privacy Policy

Location, schedule and contract conditions

For this overseas or regional listing, confirm work authorisation and any location restrictions with the employer. The location does not establish visa sponsorship or permission to work remotely from India.

• Oscar is the first health insurance company built around a full stack technology platform and a relentless 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
• Work arrangement: Remote
• Advertised location: Remote

Pay and application dates

A verified salary figure is not established in this article. An online estimate for another Physician Reviewer - Utilization Management vacancy is not an offer for reference 8303962; use the employer’s own pay disclosure and recruitment communication.

A closing date is not confirmed in this article. Check the current employer page before submitting: an undated posting can change or be withdrawn.

How to apply to Oscar Health

Applications follow the official employer page linked below.

Open the official Oscar Health posting below and match the title and reference 8303962.

Compare your qualifications and experience with the essential conditions for the Remote position, then read the preferred criteria separately.

Prepare an accurate CV and the supporting items requested in that employer’s application. Provide only information and documents you are authorised to share.

Use the employer’s application option, complete the required fields and review the submission. Retain the acknowledgement when one is provided. Job Alerts World does not receive the application.

Practical preparation: AI

An AI-related example should make the task and evaluation explicit. Explain the inputs, the system’s intended output and how you checked errors, usefulness or reliability, rather than relying on the model name alone.

Relevant skills

• AI/ML
• AI
• pharmacy
• compliance
• insurance
• communication
• care coordination
• credentialing
• oncology