Remote Associate Medical Director, Regulatory & Credentialing

oscar; United States; Remote; USD 216,000 - 284,000; Full time

Job summary

Oscar Health is seeking an Associate Medical Director, Regulatory Management to join our Clinical Affairs team. This role leads regulatory programs, policy development, and credentialing operations to ensure compliance and high-quality provider onboarding.

You will collaborate across Quality, Network Management, and Compliance to drive improvements and support organizational growth. The position is fully remote for candidates in the United States with some travel, offering competitive pay,

Qualifications

• 7+ years healthcare experience with leadership responsibility.
• 3+ years managing provider credentialing within a health plan, MCO, or large healthcare system.
• 3+ years knowledge of NCQA credentialing standards, CMS regulations, and state laws.
• 1+ years experience managing clinical coding taxonomies.
• Demonstrated experience leading operational improvement initiatives and cross-functional partnerships.
• Strong knowledge of provider data management and credentialing systems.
• 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 to ensure alignment with laws.
• Chair Credentialing, Peer Review, and Population Health sub-committee and report metrics.
• Oversee practitioner and facility credentialing ensuring NCQA and CMS compliance.
• Partner with Network and Market Management to accelerate onboarding and close gaps.
• Collaborate on Quality Improvement for Clinical Review Operations and IRR processes.
• Identify bottlenecks to streamline processes while maintaining quality and compliance.
• Serve as SME on state and federal healthcare regulations and translate changes into updates.
• Ensure compliance with all applicable laws and regulations.
• Other duties as assigned.

Skills

Healthcare leadership

Provider credentialing

NCQA knowledge

Clinical coding taxonomy

Operational improvement

Cross-functional partnerships

Team leadership

Education

MD/DO with unrestricted license

Job description

Oscar Health is seeking an Associate Medical Director, Regulatory Management to join our Clinical Affairs team. This role leads regulatory programs, policy development, and credentialing operations to ensure compliance and high-quality provider onboarding.

You will collaborate across Quality, Network Management, and Compliance to drive improvements and support organizational growth. The position is fully remote for candidates in the United States with some travel, offering competitive pay,