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We’re unique. You should be, too. We’re changing lives every day. For both our patients and our team members. Are you innovative and entrepreneurial minded? Is your work ethic and ambition off the charts? Do you inspire others with your kindness and joy? We’re different than most primary care providers. We’re rapidly expanding and we need great people to join our team. The Physician Reviewer is the primary physician reviewer for Clinical Appropriateness Reviews cases in our organization. Other duties include advising other physician reviewers and attending daily calls with health plan teams and our local teams assisting with this function and coordinating care for our patients. The position will also participate in Process and Quality improvement in our developing area of Delegated Utilization Management. • Provides Clinical Appropriateness Reviews by covering the specified territories as assigned:, • Establish 2-3 cases a day for each market covered (up to 6 markets); ensures attendance on all health plan and local calls; calls in for the weekly Primary Care Provider (PCP) and Skilled Nursing Facility (SNF) meetings covering the assigned territories., • Advises other physician reviewers., • Other duties as assigned and modified by manager., • Excellent analytical and deductive reasoning skills, • Good judgement and problem-solving skills, • Professional and effective communication skills, • Strong organizational skills, • Written and verbal fluency in English, • Proficient in the use of Microsoft Office products such as Outlook, Excel, Word and PowerPoint, • Graduate from accredited Medical School with a valid, unrestricted license is required, • Completion of Internal Medicine or Family Practice residency, • Completion of Fellowship in Gastroenterology, • Board Certification in residency area, • Board Certification in Gastroenterology, • Two (2) years’ experience in Hospital medicine preferred, • At least one (1) year of utilization review experience preferred PAY RANGE: $204,761 - $292,515 Salary The posted pay range represents the base hourly rate or base annual full-time salary for this position. Final compensation will depend on a variety of factors including but not limited to experience, education, geographic location, and other relevant factors. This position may also be eligible for a bonuses or commissions. EMPLOYEE BENEFITS _ We’re ChenMed and we’re transforming healthcare for seniors and changing America’s healthcare for the better. Family-owned and physician-led, our unique approach allows us to improve the health and well-being of the populations we serve. We’re growing rapidly as we seek to rescue more and more seniors from inadequate health care. ChenMed is changing lives for the people we serve and the people we hire. With great compensation, comprehensive benefits, career development and advancement opportunities and so much more, our employees enjoy great work-life balance and opportunities to grow. Join our team who make a difference in people’s lives every single day. Current employees, if you want to apply to our internal career site, please click _ Current Contingent Worker please see job aid _ to apply #LI-Remote

Job DescriptionAre you looking to join a company where your contributions truly matter, and where you'll be part of a supportive, innovative team? MMS is a award-winning, data-focused clinical research organization (CRO). We pride ourselves on being a Great Place to Work certified organization, recognized for our exceptional culture and industry best employee retention rate. We support the pharmaceutical, biotech, and medical device industries with our proven, scientific approach to complex trial data and regulatory submission challenges. With a global footprint across four continents, MMS not only maintains an industry-leading customer satisfaction rating but also fosters a collaborative and inclusive work environment where employees can thrive. Join us at MMS and be part of a team that is shaping the future of clinical research. Discover more about our exciting opportunities and why MMS is a great place to advance your career. Visit www.mmsholdings.com or follow MMS on LinkedIn. This role is a project-based consulting opportunity to conduct medical reviewing on an as-needed basis. This is not a full-time position. Roles & Responsibilities • Provide medical expertise on development-related or emerging cardiac safety concerns, • Responsible for medical monitoring tasks, • Provide medical input throughout the development process, • Provide medical input into the development and execution of study documents and plans, such as study protocol, IB, SMP, DMP, SAP, Lab manuals, etc., • Provide significant expertise as primary medical reviewer of individual adverse event reports, clinical, and safety documents, • Lead safety activities on assigned product(s) that may include interactions with other functional groups in the company, • Responsible for strategies in pre and post marketing risk management, as well as keeping abreast of pharmacovigilance methods and trends in published literature and global regulations, • Responsible for strategies in monitoring and analysis of cumulative safety information, • Maintains significant knowledge of global and local regulations and guidance as they pertain to medical review and safety reportingJob Requirements, • Medical degree required (MD or equivalent), • Specialty in Cardiology or comparable experience in Cardiology, • 5 or more years of clinical experience and/ or research experience required, • Relevant experience in medical monitoring and/or medical reviewer in pharmaceutical industry, • Excellent scientific writing skills, • Ability to understand clinical data, • Proficiency with MS Office applications, • Good communication skills, • Strong knowledge of current regulatory practices and domestic and international regulations Powered by JazzHR aRtj3LGt4k

Job Description Hi, we're Oscar. We're hiring a Sr. Quality of Care Review Nurse to join our Quality team. 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. About the role: Clinical Quality programs are designed to enhance clinical outcomes and concierge-level service to our members, through review of services provided to members from network healthcare providers, facilities and Oscar employees. The Senior Quality of Care Nurse analyzes clinical data, tracks core measures, reviews patient records, and implements evidence-based strategies to improve overall provider and facility standard of care. As well as, optimizing clinical experience into clear detailed medical reviews while upholding department standards for quality and productivity. The Quality of Care Nurse Reviewer evaluates and refines healthcare processes to optimize patient safety, clinical outcomes, and regulatory compliance. You will report into the Nurse Manager, Quality of Care. Work Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; or Texas. 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: $83,628 - $109,761.75 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses. Responsibilities: • Reviewing member complaints that need to be escalated immediately and resolved within 60 calendar days of receipt through review of services provided to members from network healthcare providers, facilities and Oscar employees., • Perform quality of care review to determine whether records or commentary from the provider/facility will be needed in order to accurately determine whether a quality issue did occur., • Conduct root cause analyses for adverse events, sentinel events, or potential quality issues to prevent future occurrences., • Investigate provider and facility quality of care concerns, identifying and escalating negative performance trends for corrective action when appropriate., • Perform annual medical record reviews for selected states., • Consult with internal stakeholders to ensure that quality of care needs or members are met while adhering to accreditation and regulatory requirements., • Present quality and performance trend data to organizational stakeholders, delegates and quality subcommittees as applicable; Collaborate on corrective action plans to address identified gaps., • Compliance with all applicable laws and regulations, • Other duties as assigned Requirements: • Licensed Registered Nurse with active, unrestricted license in state of residence and willingness to obtain additional licenses as needed for Oscar's growth (with Oscar's support), • 2+ years of experience as a Registered Nurse, • 2+ years experience working in a clinical care setting Bonus points: • Health plan utilization management experience or case management experience., • Experience in healthcare quality assurance, including experience auditing medical records and evaluating clinical information and internal documentation to determine the quality of care and service provided to members., • Experience in health plan case management., • Bilingual - fluent in Spanish to audit Spanish-language verbal and written interactions., • Bachelor's Degree from an accredited university, BSN Preferred., • A working knowledge of health insurance/benefit concepts - Medicare and Individual Marketplace insurance experience a plus., • Experience with NCQA accreditation standards for utilization management, case management or population health, HEDIS measures and other regulatory requirements., • CCM or MCG certification., • Experience analyzing performance and other forms of data., • Proficiency using Google applications like Sheets, Docs, Slides and Meets., • Comfortable using Google Meets and other platforms to communicate with internal/external partners. 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. 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. Reasonable Accommodation: 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 (accommodations@hioscar.com) to make the need for an accommodation known. 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.

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