Remote Associate Medical Director, Regulatory & Credentialing

Oscar Health, Inc.; United States; Remote; USD 216,000 - 284,000; Full time

Job summary

Oscar Health, Inc. in the United States seeks an Associate Medical Director, Regulatory Management to lead provider clinical regulatory programs and credentialing within our Clinical Affairs team.

This remote role is available to candidates nationwide (excluding certain states). It offers base pay between $216,108 and $283,642 per year, plus benefits, unlimited vacation, and annual bonuses.

Qualifications

• 7+ years of progressive healthcare experience with leadership responsibility.
• 3+ years managing provider credentialing within a health plan or large system.
• 3+ years knowledge of NCQA/CMS regulations and state requirements.
• 1+ years working with clinical coding taxonomies.
• Experience leading cross-functional process improvements.
• Strong provider data management and verification experience.

Responsibilities

• Build and lead the Clinical Policy Compliance team and the Clinical Coding Center of Excellence.
• Direct the development of clinical regulatory policies and SOPs with state and federal alignment.
• Chair sub-committees on credentialing, peer review, and population health management.
• Oversee practitioner and facility credentialing ensuring NCQA and CMS compliance.
• Partner to accelerate provider onboarding while maintaining credentialing integrity.
• Collaborate on Quality Improvement for Clinical Review Operations and IRR processes.
• Identify operational bottlenecks and enhance member/provider satisfaction without compromising compliance.
• Act as subject matter expert on healthcare regulations and translate changes into updates.

Skills

Healthcare leadership

Credentialing management

Regulatory compliance

Cross-functional collaboration

Operational improvement

Data management

Team leadership

Communication skills

Education

MD/DO license

Board certification

Job description

Oscar Health, Inc. in the United States seeks an Associate Medical Director, Regulatory Management to lead provider clinical regulatory programs and credentialing within our Clinical Affairs team.

This remote role is available to candidates nationwide (excluding certain states). It offers base pay between $216,108 and $283,642 per year, plus benefits, unlimited vacation, and annual bonuses.