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Salary: USD 261,565 - 343,304 / annual
Oscar Health is seeking a Market Medical Officer for the Central region to serve as the clinical executive leading the Clinical Affairs team. This role is responsible for driving market performance, expanding care access, and enhancing affordability across the Central region while optimizing medical cost trends and reimbursement strategies.
You will report to the VP of Clinical Affairs and serve as the primary clinical liaison between corporate operations and local provider leadership. Key responsibilities include:
- Drive performance of key clinical metrics (ED/K, APK, ALOS, etc.) for trend management and market performance in partnership with market P&L leadership
- Partner with Medical Economics to identify market-based utilization trends and develop solutions to reduce overall spend
- Build strategic partnerships with health systems, physician groups, and community providers to align incentives and lower total cost of care
- Serve as regional clinical partner across internal teams including Affordability, Utilization Management, Care Management, and Claims
- Partner with Network Contracting leadership to guide clinical initiatives that enhance provider alignment, care quality, and clinical outcomes
- Identify and resolve regional network gaps and access barriers to advance equitable, high-quality care
- Collaborate with regulatory agencies and compliance teams to ensure regional network adequacy and quality programs comply with state and federal requirements
- Serve as point of accountability for regional escalations including appeals, provider and member grievances, and complex case management
- Ensure compliance with all applicable laws and regulations
The role is remote, open to candidates residing in Arizona, Florida, Georgia, Illinois, Iowa, Kansas, Michigan, Missouri, Nebraska, New Jersey, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, or Virginia. Occasional travel may be required for team meetings and company events.
REQUIREMENTS:
- 12+ years of progressive leadership experience in healthcare
- 10+ years of experience in managed care with prior experience leading in a matrix environment
- 7+ years of clinical leadership experience in market-specific role
- 7+ years of experience managing clinical market trends in health insurance or full risk-bearing clinical provider groups
- 5+ years of clinical practice and board certified in one of the following: internal medicine, family medicine, general surgery, emergency medicine (other fields considered)
- 5+ years of experience leading teams
- MD or DO with current unrestricted license to practice medicine required in one of these states: Illinois, Indiana, Michigan, Ohio, Iowa, Kansas, Nebraska
- Must maintain active board certification
- Willing and able to obtain additional state licensure with Oscar's support
BONUS QUALIFICATIONS:
- P&L experience for risk-bearing entity
- Licensure in multiple Oscar states
- Master's degree or advanced certificate
- Prior experience with Utilization Management
