Associate Medical Director, Regulatory Management

Oscar Health

. Build and lead the Clinical Policy Compliance team and the Clinical Coding Center of Excellence .

Posted 9/18/2026full-timeRemote • Florida • United StatesLead💰 $216,108 - $283,642 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates extensive expertise in clinical policy compliance, provider credentialing, and regulatory strategy within healthcare. Proven leadership in managing cross-functional teams and driving operational improvements while ensuring adherence to NCQA and CMS standards.

Highest-signal resume keywords

Clinical Policy Compliance LeadershipProvider Credentialing ManagementNCQA Standards KnowledgeOperational Improvement InitiativesRegulatory Strategy Development

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical Coding TaxonomiesProvider Data ManagementPrimary Source Verification ProcessesQuality Improvement InitiativesOperational SOP DevelopmentBenefit Interpretation PoliciesCase Review ManagementKey Performance Metrics ReportingCompliance MonitoringHealthcare Regulatory Knowledge

Soft Skills

Team LeadershipCross-Functional CollaborationProblem SolvingPrioritizationCommunication

Certifications & Qualifications

MD or DO LicenseActive Board Certification

Industry Keywords

Healthcare ComplianceManaged Care OrganizationCredentialing StandardsCMS RequirementsState RegulationsQuality ImprovementPopulation Health ManagementLegal Developments MonitoringOperational Bottlenecks ResolutionProvider Onboarding

About the role

Key responsibilities & impact

Build and lead the Clinical Policy Compliance team and the Clinical Coding Center of Excellence
Drive compliance, quality, and regulatory strategy across the organization
Direct development of clinical regulatory policies, Benefit Interpretation Policies (BIPs), and operational SOPs aligned with state and federal laws
Chair the Credentialing, Peer Review, and Population Health Management sub-committee
Drive individual case reviews and report key performance metrics to quarterly Quality Improvement meetings
Oversee practitioner and facility credentialing for compliance with NCQA standards, CMS requirements, and state regulations
Verify licenses, board certifications, and sanction histories
Partner with Network and Market Management executives on provider onboarding and network gaps
Collaborate on Quality Improvement for Clinical Review Operations, including IRR processes, clinical delegate audits, and PQI workflows
Identify and resolve operational bottlenecks
Serve as a subject matter expert on state and federal healthcare regulations
Monitor legal developments and translate regulatory changes into operational updates
Comply with all applicable laws and regulations
Perform other duties as assigned

Requirements

What you’ll need

7+ years of progressive healthcare experience, including leadership responsibility
3+ years experience managing provider credentialing within a health plan, managed care organization, or large healthcare system
3+ years knowledge of NCQA credentialing standards, CMS health plan regulatory requirements, and applicable federal and state regulations
1+ years experience managing and working with clinical coding taxonomies
Demonstrated experience leading operational improvement initiatives and managing cross-functional partnerships
Strong knowledge of provider data management, credentialing systems, and primary source verification processes
Proven ability to lead teams, manage competing priorities, and lead measurable operational results
MD or DO with a current unrestricted license to practice medicine is required
Necessary credentials must be maintained, including active board certification
Willingness to obtain additional state licensure with Oscar's support

Benefits

Comp & perks

Employee benefits
Unlimited vacation program
Annual performance bonuses
Medical, dental, and vision benefits
11 paid holidays
Paid sick time
Paid parental leave
401(k) plan participation
Life and disability insurance
Paid wellness time and reimbursements
Oscar support for obtaining additional state licensure