Medical Director, Clinical Regulatory Affairs

Oscar Health

🔍 Observed

$219K - $287K USD

Remote First seen 3 weeks ago Last seen 3 hours, 42 minutes ago Greenhouse

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Job Description

AI Summary

• Lead and oversee Clinical Policy, Regulatory Compliance, and Clinical Affairs functions to ensure Oscar Health's operations meet healthcare laws, standards, and regulatory requirements. • Requires active MD/DO license with 10+ years healthcare/insurance experience, 5+ years clinical policy compliance, and 5+ years applying state/federal health insurance regulations. • Develop and maintain clinical policy documents, manage compliance processes, advise senior leadership on regulatory risks, and support interactions with federal/state regulators (FDA, CMS, state DOI). • Base salary $218,592–$286,902 annually plus equity grants, performance bonuses, unlimited vacation, and employee benefits; remote role with required residency in 23+ specified states. • Reports to VP of Clinical Affairs and manages a team; bonus qualifications include JD/legal training and experience with ACA or commercial health plans.

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

Oscar is the first health insurance company built around a full stack technology platform and a relentless 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 build and oversee the Clinical Policy, Regulatory, and Compliance functions within the Office of Clinical Affairs. You will ensure our clinical operations meet healthcare laws and standards, develop and maintain regulatory policies, manage compliance risks, and guide policy-related submissions. You will advise senior leadership and work closely with teams across the organization to ensure clinical operations align with policy and regulatory intent.

You will report into the VP, Clinical Affairs

Work Location: You must reside in one of the following states: Arizona, California, Colorado, Connecticut, D.C., Florida, Georgia, Illinois, Iowa, Maryland, Massachusetts, Michigan, New Hampshire, New Jersey, New Mexico, New York City, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, Tennessee, Texas, or Utah. Note, this list of states is subject to change. #LI-Remote

Pay Transparency: The base pay for this role is: $218,592 - $286,902 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program, company equity grants and annual performance bonuses.

Responsibilities:

Lead and grow the Clinical Policy & Regulatory Affairs team.
Build and manage processes that ensure clinical policy compliance and quality.
Develop and maintain BIPs, SOPs, and other clinical policy documents aligned with QMS.
Serve as a regulatory compliance expert and maintain strong relationships with key clinical teams.
Deliver executive briefings on regulatory and policy impacts.
Advise the CMO and senior leaders on compliance risks and strategy.
Support interactions with federal and state regulators (FDA, CMS, state DOI).
Oversee the Clinical Coding Center of Excellence and clinical credentialing.
Promote a culture of compliance through training and education.
Collaborate effectively with stakeholders across the organization.

Requirements:

Active, unrestricted MD or DO license
10+ years of experience in healthcare or the health insurance industry
5+ years of experience in clinical policy compliance or clinical regulatory/government affairs
5+ years applying state and federal health insurance laws and regulations (Marketplace, MA, reporting, and audit requirements)
5+ years preparing and presenting reports to boards of directors
5+ year of team leadership and people development experience

Bonus points:

JD or other legal training/certification
Experience with ACA or commercial health plans
Experience working in a fast-paced, collaborative environment

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.

Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.

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 Privacy Policy.

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Job Information

Company:
Oscar Health
Location:
Remote
Work Location:
Remote
Experience Level:
Senior
Source:
Greenhouse
Status:
Active

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65 /100

Likely Active (65)

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