Senior Medical Director, Utilization Management Operations

Hi, we're Oscar. We're hiring a Senior Medical Director to join our Utilization Management Operations 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 oversee the operations of Utilization Management. You will lead a team of clinical leaders who provide oversight of clinicians, provide leadership to managers and are accountable for overall team performance metrics. In collaboration with partners, you will play a key role in strengthening function and driving clinical improvement within the organization.

You will report to the VP, Clinical Operations.

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 Ave), 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, Iowa, Kentucky, Maryland, Massachusetts, Michigan, Minnesota, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, 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

• 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, 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
• Serve as point of accountability for escalated …