Oscar Health - Market Medical Officer, Central
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 experience of clinical leadership in role specific market. • 7+ years of experience managing clinical market trend in health insurance or full risk bearing clinical provider groups. • 5+ years of clinical practice and board certified in one of the following fields: internal medicine, family medicine, general surgery, emergency medicine (other fields will be considered). • 5+ years of experience leading teams. • Education: • MD or DO with a current unrestricted license to practice medicine is required in a state in the region (Illinois, Indiana, Michigan, Ohio, Iowa, Kansas, Nebraska). • License and Certification: • Reviewers must maintain necessary credentials to retain the position including maintaining active board certification. • Willing and able to obtain additional state licensure (with Oscar's support). • P&L experience for risk bearing entity. • Licensure in multiple Oscar states. • Masters degree or advanced certificate. • Prior experience with Utilization management. • This is an authentic Oscar Health job opportunity.
Responsibilities
• Drive performance of key clinical metrics for trend management and market performance of plans in their region including but not limited to ED/K, APK, ALOS and others in partnership with market P&L leadership. • Work in partnership with Med Econ to identify market based utilization trends and flares and develop solutions to address key drivers to reduce overall spend. • Build strategic partnerships with health systems, physician groups, and community providers to align incentives and lower the total cost of care. • Serve as regional clinical partner across internal teams, partnering closely with Affordability, Utilization Management (UM), Care Management (CM), Claims, and others to drive regional performance goals. • Partner with Network Contracting leadership to guide clinical initiatives that enhance provider alignment, care quality, and clinical outcomes across the region. • Proactively identify and resolve regional network gaps and access barriers to advance equitable, high-quality care across all member populations. • Collaborate with regulatory agencies and compliance teams to ensure regional network adequacy and quality programs comply with state and federal requirements, translating policy changes into proactive operational strategy that protect member access and organizational performance. • Serve as the point of accountability for regional escalations, including internal/external appeals, provider and member grievances, and complex case management scenarios. • Compliance with all applicable laws and regulations. • Other responsibilities as assigned.
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