Senior Medical Director, Utilization Management Operations

 Published 4 days ago
    
 United States
    
 $280,800 - $368,550
Apply Now Please mention DailyRemote when applying

Disclaimer: Before you apply, please make sure the job is legit.

Attempting to apply for jobs might take you off this site to a different website not owned by us. Any consequence as a result for attempting to apply for jobs is strictly at your own risk and we assume no liability.

Hi, we're Oscar. We're hiring a Senior Medical Director to join our Utilization Management Operations 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 oversee the operations of Utilization Management. You will lead a team of clinical leaders who provide oversight of clinicians, provide leadership to managers and are accountable for overall team performance metrics. In collaboration with partners, you will play a key role in strengthening function and driving clinical improvement within the organization.

You will report to the VP, Clinical Operations.

Work Location: 

Oscar is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture and our mission. 

If you live within commutable distance to our New York City office ( in Hudson Square), our Tempe office (off the 101 at University Ave), or our Los Angeles office (in Marina Del Rey), you will be expected to come into the office at least two days each week. Otherwise, this is a remote / work-from-home role. 

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

Pay Transparency:

The base pay for this role is: $280,800 - $368,550 per year. You are also eligible for employee benefits, participation in Oscar’s unlimited vacation program, company equity grants and annual performance bonuses.

Responsibilities

  • 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, 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
  • Serve as point of accountability for escalated clinical issues, including internal and external appeals, member and provider complaints and grievances, and complex case management escalations
  • Conduct timely 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

Qualifications

Licensure:

  • 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)

Experience:

  • 12+ years of experience in the healthcare industry, including:
    • 5+ years of clinical practice and board certification in one of the following specialties: internal medicine, family medicine, general surgery, emergency medicine (other specialties will be considered)
    • 5+ years of utilization management experience in managed care
    • 7+ years experience leading people and teams
    • Experience with Affordable Care Act insurance products

Bonus Points

Licensure:

  • Licensure in multiple Oscar states
  • Masters degree or advanced certificate

Experience:

  • Experience with conducting quality-of-care investigations and peer reviews and developing performance improvement plans

Ace Your Job Interview

Read our advice on how to answer the most common interview questions.