Senior Medical Director, Case Management
Hi, we're Oscar. We're hiring a Senior Medical Director to join our Case Management 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
You will support executive level clinical leadership over the clinical care team including case management, complex case management, quality and training and clinical support teams. You will have scope over our CM nurses and Social Workers, and non clinical colleagues to help ensure high quality, coordinated care for some of our most fragile members. You will lead strategy and program enhancements to improve their organization. You will also work with operations partners to support projects aimed at strengthening our utilization review function and driving to our clinical goals.
You will report to the SVP, Service Operations.
This is a remote / work-from-home role. You must reside in one of the following states: Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Iowa, Maryland, Massachusetts, Michigan, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, Tennessee, Texas, Utah, Virginia, Washington, or Washington, D.C. Note, this list of states is subject to change. #LI-Remote
The base pay for this role is: $285,936 - $375,291 per year. You are also eligible for employee benefits, participation in Oscar’s unlimited vacation program, company equity grants, and annual performance bonuses.
- Provide clinical leadership and manage the strategy and budget for the Clinical Care Team
- Be the main liaison between those departments and executive leadership both internally and externally
- Work with your optimization dyad partner to ensure that clinical resources are being used to maximize quality of care and administrative efficiency with an eye towards our MLR goals
- Determine, document, and implement appropriate clinical processes, workflows, and controls
- Attain familiarity with applicable regulatory and accreditation requirements and Oscar tools and workflows to ensure they are met.
- Be the main escalation point for the clinical care team of nurses and social workers.
- Be the clinical point person with our +O clients for Case Management and Complex Case Management
- MD or DO
- Board Certified in one of the following specialties: Internal Medicine, Family Medicine, Emergency Medicine, or General Surgery
- Current unrestricted state license(s) to practice medicine. Willing to obtain additional state licenses, with Oscar's support.
- 5+ years clinical leadership experience in a position at a managed care company, at a delegated provider or plan
- 3+ years clinical practice in one of the following fields: internal medicine, family medicine, general surgery, emergency medicine.
- Experience in case management in the managed care industry or a provider system
- Comfortable with technology; willing and able to learn new software tools
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..
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.
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 (firstname.lastname@example.org) to make the need for an accommodation known.
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