Market Medical Officer, Central
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What you'll do
- 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.
What they're looking for
- 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.
- 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).
- 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).
Nice to have
- P&L experience for risk bearing entity.
- Licensure in multiple Oscar states.
- Masters degree or advanced certificate.
- Prior experience with Utilization management.
Summarised by NextRaise from the employer’s description, which follows in full below.
Full description from employer
Hi, we're Oscar. We're hiring a Market Medical Director, Central to join our Clinical Affairs team.
Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.
About the role:
The Market Medical Officer is the clinical executive for Central region, partnering with P&L leadership to drive market performance, expand care access, and enhance affordability. You will optimize medical cost trends and reimbursement strategies to balance financial sustainability with plan performance. As the primary clinical liaison, the Market Medical Officer executes regional initiatives while seamlessly bridging corporate operations with local provider leadership.
You will report into our VP of Clinical Affairs.
Work Location: This position is fully remote and open to candidates residing in the U.S., excluding Alaska; Delaware; Hawaii; Louisiana; Montana; North Dakota; Oklahoma; West Virginia; Wyoming; and U.S. Territories. Daily work is completed from your home office, with occasional travel required for team meetings and company events. #LI-Remote
Pay Transparency: The base pay for this role in the states of California, Connecticut, New Jersey, New York, and Washington is: $290,628- $381,449 per year. The base pay for this role in all other locations is: $261,565 - $343,304 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program, company equity grants and annual performance bonuses.
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.
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).
Bonus points:
- 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.
At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.
Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.
Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.
Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant’s disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known.
California Residents: For information about our collection, use, and disclosure of applicants’ personal information as well as applicants’ rights over their personal information, please see our Privacy Policy.
Company
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