Remote Senior Medical Director

Summary

Join Oscar's Clinical Member Services team as a Senior Medical Director, defining and developing clinical strategy for improving healthcare quality while controlling costs.

Requirements

• 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)
• 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

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

Benefits

• 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
• Paid wellness time and reimbursements