Remote Medical Director, Regulatory & Credentialing

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

Job summary

Oscar Health is seeking an Associate Medical Director, Regulatory Management to lead regulatory policy and credentialing at a national level. This remote role supports the Clinical Affairs team, ensuring alignment with state and federal laws and driving high-impact compliance strategy.

The position requires an MD or DO with current license, plus 7+ years in healthcare leadership and 3+ years in provider credentialing.

Qualifications

• 7+ years of progressive healthcare experience including leadership responsibilities
• 3+ years experience managing provider credentialing within a health plan, MCO, or large healthcare system
• 3+ years knowledge of NCQA credentialing standards, CMS regulatory requirements, and state/federal regs
• 1+ years experience managing and working with clinical coding taxonomies
• Demonstrated experience leading operational improvement initiatives and cross-functional partnerships
• Strong knowledge of provider data management, credentialing systems, and primary source verification
• Proven ability to lead teams, manage priorities, and deliver measurable operational results

Responsibilities

• Build and lead the Clinical Policy Compliance team and the Clinical Coding Center of Excellence
• Direct development of clinical regulatory policies, BIPs, and SOPs with SMEs
• Chair the Credentialing, Peer Review, and Population Health Management sub-committee
• Oversee practitioner and facility credentialing to ensure NCQA, CMS, and state requirements
• Partner with Network and Market Management to onboard providers and resolve gaps
• Collaborate on Quality Improvement for Clinical Review Operations and PQI workflows
• Identify operational bottlenecks to streamline processes and improve satisfaction
• 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

Regulatory leadership

Clinical policy

Credentialing management

Regulatory compliance

Team leadership

Education

MD/DO with license

Master's degree or advanced certificate

Job description

Oscar Health is seeking an Associate Medical Director, Regulatory Management to lead regulatory policy and credentialing at a national level. This remote role supports the Clinical Affairs team, ensuring alignment with state and federal laws and driving high-impact compliance strategy.

The position requires an MD or DO with current license, plus 7+ years in healthcare leadership and 3+ years in provider credentialing.