Remote Associate Medical Director, Regulatory & Credentialing

Oscar Health; United States; On-site; USD 216,000 - 284,000; Full time

Benefits offered by this job

Unlimited vacation

Medical, dental, vision benefits

11 paid holidays

Paid sick time

Paid parental leave

401(k) plan participation

Life and disability insurance

Wellness time and reimbursements

Job summary

Oscar Health is seeking an Associate Medical Director, Regulatory Management to join our Clinical Affairs team in a fully remote capacity for candidates across the U.S. (with certain state exclusions).

You will lead regulatory policy and credentialing initiatives, partnering across functions to ensure compliant, high-quality care delivery. The role demands senior clinical leadership, extensive credentialing experience, and the ability to translate complex regulations into actionable operations.

Qualifications

• 7+ years of progressive healthcare leadership experience.
• 3+ years experience managing provider credentialing within a health plan or large healthcare system.
• 3+ years knowledge of NCQA credentialing standards, CMS requirements, and state/federal regulations.
• 1+ years experience managing clinical coding taxonomies.
• Experience leading operational improvement initiatives and cross-functional partnerships.
• Strong knowledge of provider data management and verification processes.
• Proven ability to lead teams and manage competing priorities.

Responsibilities

• Build and lead the Clinical Policy Compliance team and the Clinical Coding Center of Excellence.
• Direct development of clinical regulatory policies and SOPs with SMEs.
• Chair Credentialing, Peer Review, and Population Health sub-committee and report KPIs.
• Oversee credentialing for practitioners and facilities to meet NCQA and CMS standards.
• Partner with Network and Market Management to accelerate provider onboarding while maintaining credentialing integrity.
• Collaborate on Quality Improvement and IRR processes and PQI workflows.
• Identify bottlenecks to streamline processes and improve member/provider satisfaction.
• Monitor state and federal regulations and translate changes into proactive updates.
• Ensure compliance with all applicable laws and regulations.
• Other duties as assigned.

Skills

Leadership

Provider credentialing

NCQA standards

CMS regulations

Clinical coding

Operational improvement

Data management

Cross-functional teams

Board certification

Medical licensure

Education

MD or DO

Active medical license

Board certification maintenance

Tools

Job description

Oscar Health is seeking an Associate Medical Director, Regulatory Management to join our Clinical Affairs team in a fully remote capacity for candidates across the U.S. (with certain state exclusions).

You will lead regulatory policy and credentialing initiatives, partnering across functions to ensure compliant, high-quality care delivery. The role demands senior clinical leadership, extensive credentialing experience, and the ability to translate complex regulations into actionable operations.