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

The Senior Medical Director of Utilization Management & Clinical Policy Strategy will be responsible for partnering with senior leaders in the operations and technology organizations to define, design and implement Oscar’s UM program and authorization strategy. This will involve collaboration with business units across the organization to integrate and align the authorization strategy with Oscar’s clinical policy, payment integrity, and network development strategies to optimize quality and cost of care. This role will have direct oversight and management of the physician reviewer team.

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

• Partner with operational and technology leadership to define and execute on a best-in-class Utilization Management program, in particular development of programs and initiatives that optimize the quality and cost of care.
• Develop and implement Oscar’s authorization strategy, including direct management of the physician reviewer team
• Utilize data to monitor program performance as well as to build and refine business cases in support of new programs and initiatives
• Serve as the clinical liaison pertaining to Oscar’s Utilization Management program for the payment integrity, network contracting and regulatory affairs functions
• Serve as a participant and/or chairperson of Quality Improvement committees (e.g. UM Subcommittee) as applicable.
• Compliance with all applicable laws and regulations
• Other duties as assigned

Qualifications

• Board certified or eligible MD or DO with a current unrestricted license to practice medicine in the US.
• 12+ years of experience in the healthcare industry, including 3+ years of clinical practice with specialization in one of the following fields: internal medicine, family medicine, general surgery, emergency medicine (other fields will be considered)
• 5+ years of utilization review experience in a managed care plan (health care industry)
• 3+ years of leadership experience as a people manager

Bonus Points

• An advanced degree or certificate in business, or equivalent experience.
• Experience in a startup: understanding the pace and culture.
• Experience with Affordable Care Act insurance products.
• Licensure in multiple Oscar states and/or willing to obtain additional state licenses, with Oscar's support.

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 ([email protected]) to make the need for an accommodation known.

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