Appeals Decision Maker

5 days ago


Tempe, Arizona, United States Oscar Health Full time
About the Job: We are seeking a highly skilled and experienced MEDICAL NECESSITY REVIEWER to join our team at Oscar Health.

In this role, you will be responsible for conducting thorough medical necessity reviews and level of care reviews for requested services, using clinical judgment and Oscar Clinical Guidelines, Milliman Care Guidelines, and other relevant resources.

You will work closely with the Nurse Supervisor to ensure that all reviews are completed efficiently and effectively, meeting required decision-making SLAs.

A key aspect of this role is referring members for further care engagement when necessary, ensuring that they receive the appropriate level of care.

To succeed in this role, you will need to have strong clinical skills, excellent communication skills, and the ability to work independently in a fast-paced environment.

The base pay for this role is $35.00 - $45.95 per hour, and you will also be eligible for employee 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.



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