Medical Director, Clinical Regulatory Affairs

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:

As an executive physician leader in this role, you will develop 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 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: $240,120 - $315,157.50 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 the Clinical Policy & Regulatory Affairs team.
• Build and manage processes that ensure clinical policy compliance and quality.
• Develop BIPs, SOPs, and other clinical policy documents aligned with QMS.
• Be a regulatory compliance expert and maintain relationships with important 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 with team members 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 in addition to physician credentials
• Experience with ACA or commercial health plans