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Salary: USD 237,719 - 312,006 / annual
Oscar Health is seeking a Medical Director, Scientific Affairs to lead the Clinical Affairs team's evidence-based policy development and clinical strategy. Reporting to the Vice President of Clinical Affairs, you will serve as the organization's primary scientific authority, translating clinical research into actionable strategies that elevate care quality across the health plan.
Key responsibilities include:
- Lead research, development, and revision of all medical, utilization management (UM), and pharmacy coverage policies, ensuring clinical accuracy and evidence-based rigor
- Serve as subject matter expert on emerging medical therapies, complex clinical trends, and population health utilization patterns; advise executive leadership using data-driven insights
- Direct Oscar's clinical publishing efforts and foster academic partnerships to advance and publish clinical research leveraging health plan population data
- Systematically review major specialty society guidelines (ASCO, ACC, AACE, etc.) to ensure policies reflect established standards of care
- Establish and maintain formal frameworks for grading clinical evidence, anchoring all medical and pharmacy policies in high-quality, peer-reviewed literature
- Oversee Clinical Advisory Subcommittees, setting agendas, presenting evidence packages, and driving expert consensus on policy decisions
- Support development of clinical and lifestyle products through evidence-based research tailored to target populations
- Partner with Pharmacy Services (P&T Committee), Legal, and Compliance to integrate coverage policies meeting NCQA standards and state/federal mandates
- Support interactions with regulatory bodies (FDA, CMS, State Departments of Insurance) as needed
This is a fully remote position open to candidates residing in Atlanta, Georgia, with potential for future hybrid presence at the Atlanta hub office.
Requirements:
- Medical Degree (MD or DO) from an accredited school of medicine or osteopathic medicine
- Active board certification recognized by ABMS or AOA
- 10+ years working in relevant fields
- 6+ years clinical policy experience in health insurance, PBM, or clinical guideline development organization
- 4+ years clinical policy drafting and development
- 4+ years leading, chairing, or facilitating multi-disciplinary clinical committees or advisory subcommittees
- 4+ years publishing in relevant fields
- 3+ years communicating with executives and interacting across all organizational levels
- 3+ years leadership experience as a people manager
- 1+ years experience with medical coding terminologies (HCPCS, CPT, ICD-10)
Bonus qualifications:
- Demonstrated experience analyzing clinical trials and medical literature
- Track record of publishing in peer-reviewed clinical journals or serving on an IRB or Clinical Practice Guideline panel
- PhD or Master's in Clinical Research
