Medical Director, Clinical Regulatory Affairs at Oscar Health

Atlanta, Georgia, United States -

Full Time

Start Date

Immediate

Expiry Date

21 Apr, 26

Salary

286902.0

Posted On

21 Jan, 26

Experience

10 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Clinical Policy, Regulatory Affairs, Compliance, Healthcare Laws, Team Leadership, Risk Management, Policy Development, Executive Briefings, Stakeholder Collaboration, Clinical Operations, Regulatory Compliance, Clinical Credentialing, Training, Education, Health Insurance, Government Affairs

Industry

Insurance

Description

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: This is a remote position, open to candidates who reside in: Atlanta, Georgia. You will be fully remote; however, our approach to work may adapt over time. Future models could potentially involve a hybrid presence at the hub office associated with your metro area. #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, 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.

Responsibilities

You will build and oversee the Clinical Policy, Regulatory, and Compliance functions within the Office of Clinical Affairs. This includes ensuring clinical operations meet healthcare laws and standards, managing compliance risks, and advising senior leadership.