Qualifications:

Licensure:

• MD or DO with a current unrestricted license to practice medicine in the US and specifically in California.
• Licensure in multiple Oscar states (dependent on region) preferred but not required; you should be willing to obtain additional state licenses, with Oscar's support.
• Board-certified or eligible in psychiatry

Experience:

• 3+ years in clinical practice
• 3+ years experience in the managed care industry or a provider system
• Experience with presentations to regulators, provider systems, accreditation organizations and / or executive leadership

Corporate leadership:

• Provide clinical leadership for behavioral health strategic initiatives and care management.
• Develop innovative models, including payment models, integrated care models, and virtual care models, to support Oscar’s behavioral health strategy.
• Support expansion efforts by obtaining necessary licensure and serving as a clinical representative with regulators.
• Demonstrate the highest level of professionalism, accountability, and service in your interactions with teammates, providers, and members.
• Work with fellow regional medical directors, corporate leaders, and the Chief Clinical Officer in setting the strategic medical management agenda.
• Become a source of inspiration and subject matter expert for the build-out of technology and data tools.

Locoregional leadership:

• Establish yourself as the local clinical representative for internal stakeholders and liaison to external parties such as our provider partners and clinical vendors.
• Develop a strong working relationship with regulators in the state, including the Office of Insurance, and represent the company in clinical matters and audits.
• Establish oversight responsibility for clinical functions in your region, including medical management and quality improvement, and interact cross-functionally with both clinical and non-clinical counterparts to support their success.
• Track and analyze key utilization and clinical performance metrics in your region, including identifying and presenting trends to internal and external meetings and committees.
• Serve as the internal and external point of accountability for escalated clinical issues in your region, including external utilization management appeals, member complaints and grievances, and complex case management escalations.
• Develop familiarity with applicable regulatory and accreditation requirements as well as our tools, teams, and workflows in place to ensure we meet them.