Oscar Health - Medical Director Scientific Affairs
Requirements
• 10+ years working in relevant fields. • 6+ years clinical policy experience in health insurance, PBM, or other clinical guideline development organization. • 4+ years experience in clinical policy drafting and development. • 4+ Years of experience leading, chairing, or facilitating multi-disciplinary clinical committees or advisory subcommittees. • 4+ years publishing in relevant fields. • 3+ years of experience communicating with executives and interacting with all levels of the organization. • 3+ years of leadership experience as a people manager. • 1+ years of experience with medical coding terminologies (HCPCs, CPT, ICD-10). • Medical Degree (MD or DO): Required from an accredited school of medicine or osteopathic medicine. • Board Certification: Active board certification recognized by the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA). • Demonstrated experience analyzing clinical trials and medical literature. • A track record of publishing in peer-reviewed clinical journals or serving on an Institutional Review Board (IRB) or Clinical Practice Guideline panel is highly desirable. • PhD or Masters in Clinical Research. • This is an authentic Oscar Health job opportunity.
Responsibilities
• Serve as the primary evidence-based subject matter expert, translating clinical research into actionable strategies to elevate care quality across the organization. • Lead the research, development, revision, and clinical accuracy of all medical, utilization management (UM), and pharmacy coverage policies. • Advise executive leadership on emerging medical therapies, complex clinical trends, and population health utilization patterns using data-driven insights. • Support the development of clinical and lifestyle products through the production of evidence based research tailored to target populations. • Foster academic partnerships to advance and publish clinical research leveraging health plan population data. • Lead the systematic review of major specialty society guidelines (e.g., ASCO, ACC, AACE), ensuring policies reflect established standards of care and objective evidence evaluation. • Establish, maintain, and enforce the formal framework for grading clinical evidence, ensuring all medical and pharmacy policies are anchored in high-quality, peer-reviewed literature. • Oversee Clinical Advisory Subcommittees - setting agendas, presenting clinical evidence packages, and driving expert consensus to guide policy decisions. • Partner with Pharmacy Services (P&T Committee), Legal, and Compliance to seamlessly integrate coverage policies that meet or exceed NCQA standards and state/federal mandates. • Support interactions with federal and state regulatory bodies (e.g., FDA, CMS, State DOIs) as needed. • Compliance with all applicable laws and regulations. • Other responsibilities as assigned.
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