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
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
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.
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.