Associate Medical Director, Regulatory Management

🔥 0 minutes ago

🐊 Florida – Remote

🐊 Florida – Remote

💵 $216.1k - $283.6k / year

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

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Oscar Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2012

⚕️ Healthcare Insurance

🏥 Healthcare

💰 $355M Post-IPO Debt - Oscar Health on 2025-09

Healthcare Insurance • Healthcare

Oscar Health is a technology-driven health insurance company that provides individual, family, and small-group health plans in multiple U. S. states. Oscar combines traditional insurance underwriting with digital-first services — a consumer-facing app, 24/7 virtual urgent care, prescription delivery (including $3 meds in many plans), and dedicated Care Teams — and also operates Oscar Primary Care in some markets. The company emphasizes accessible, affordable, high-quality care and uses AI to improve member experience and care delivery. Insurance policies are underwritten by Oscar's state insurance subsidiaries and the company offers both HMO and other plan types across its markets.

📋 Description

• Build and lead the Clinical Policy Compliance team and the Clinical Coding Center of Excellence • Drive compliance, quality, and regulatory strategy across the organization • Direct development of clinical regulatory policies, Benefit Interpretation Policies (BIPs), and operational SOPs aligned with state and federal laws • Chair the Credentialing, Peer Review, and Population Health Management sub-committee • Drive individual case reviews and report key performance metrics to quarterly Quality Improvement meetings • Oversee practitioner and facility credentialing for compliance with NCQA standards, CMS requirements, and state regulations • Verify licenses, board certifications, and sanction histories • Partner with Network and Market Management executives on provider onboarding and network gaps • Collaborate on Quality Improvement for Clinical Review Operations, including IRR processes, clinical delegate audits, and PQI workflows • Identify and resolve operational bottlenecks • Serve as a subject matter expert on state and federal healthcare regulations • Monitor legal developments and translate regulatory changes into operational updates • Comply with all applicable laws and regulations • Perform other duties as assigned

🎯 Requirements

• 7+ years of progressive healthcare experience, including leadership responsibility • 3+ years experience managing provider credentialing within a health plan, managed care organization, or large healthcare system • 3+ years knowledge of NCQA credentialing standards, CMS health plan regulatory requirements, and applicable federal and state regulations • 1+ years experience managing and working with clinical coding taxonomies • Demonstrated experience leading operational improvement initiatives and managing cross-functional partnerships • Strong knowledge of provider data management, credentialing systems, and primary source verification processes • Proven ability to lead teams, manage competing priorities, and lead measurable operational results • MD or DO with a current unrestricted license to practice medicine is required • Necessary credentials must be maintained, including active board certification • Willingness to obtain additional state licensure with Oscar's support

🏖️ Benefits

• Employee benefits • Unlimited vacation program • Annual performance bonuses • Medical, dental, and vision benefits • 11 paid holidays • Paid sick time • Paid parental leave • 401(k) plan participation • Life and disability insurance • Paid wellness time and reimbursements • Oscar support for obtaining additional state licensure