Regional Medical Director

Seasoned Recruitment - Los Angeles, CA

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.




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