Senior Medical Director, Clinical Programs

Hi, we're Oscar. We're hiring a Senior Medical Director to join our Clinical Member Services team.

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

You will be responsible for defining and developing the clinical strategy for improving health care quality while controlling costs. You will analyze healthcare data and trends to assess the financial impact of medical treatments, policies and procedures and identify areas for cost containment. You will innovate and collaborate with internal stakeholders to design clinical care models and provide insights and recommendations for improving health care outcomes and cost management.

You will report to the Senior Vice President of Clinical Member Services.

Work Location: 

Oscar is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture and our mission. 

If you live within commutable distance to our New York City office (in Hudson Square), our Tempe office (off the 101 at University Dr), or our Los Angeles office (in Marina Del Rey), you will be expected to come into the office at least two days each week. Otherwise, this is a remote / work-from-home role. 

You must reside in one of the following states: Alabama, Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, Virginia, Washington, or Washington, D.C. Note, this list of states is subject to change. #LI-Remote

Pay Transparency:

The base pay for this role is: $280,800 - $368,550 per year. You are also eligible for employee benefits, participation in Oscar’s unlimited vacation program, company equity grants and annual performance bonuses.

Responsibilities

• Drive strategy of clinical programs and operations
• Oversee team of clinicians, including nurses and physicians
• Ensure team is meeting quality and productivity metrics
• Partner with internal teams to drive continuous improvement
• Develop a working mastery with applicable regulatory and accreditation requirements and ensure the department / team is meeting those requirements
• Participate in quality improvement activities (e.g., subcommittees, audits, QA, and interrater reliability testing)
• Partner with leads across the organization as necessary in order to communicate , understand and identify upstream and downstream impacts to the business
• Support departmental budgeting process including support business case justification for major investments
• Be the point of accountability for escalated clinical issues, including internal and external appeals, member and provider complaints and grievances, and complex case management escalations
• Conduct peer-to-peer discussions with referring physicians 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
• Other duties as assigned

Qualifications

Licensure:

• MD or DO with a current unrestricted license to practice medicine is required
• Reviewers must maintain necessary credentials to retain the position including maintaining active board certification
• Willing and able to obtain additional state licensure (with Oscar’s support)

Experience:

15+ years of experience to include the following:

• 5+ years of clinical practice and board certified in one of the following specialties: internal medicine, family medicine, emergency medicine (other specialties will be considered)
• 5+ years of clinical operations/clinical strategy experience in managed care (payor or provider)
• 7+ years experience leading people and teams

Bonus Points

Licensure:

• Licensure in multiple Oscar states
• Masters degree or advanced certificate

Experience:

• Experience with conducting quality-of-care investigations and peer reviews and developing performance improvement plans.

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.

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 Notice to Job Applicants.