Oscar Health

Nurse Practitioner

• Provide high-quality care for patients in a virtual setting
• Use prescriptive authority as part of a collaborative practice agreement, consulting and partnering with Physicians on the care team for comprehensive care, particularly with complex patients
• Follow up on labs, imaging, and closed loop communication with patients and other providers
• Use tooling to allow virtual “exams” including remote home monitoring equipment, remote physical exam, and remote point of care diagnostics
• Participate in a collaborative care model with registered nurses, medical assistants, PCPs, behavioral health clinicians, and clinical supervisors where applicable
• Participate in required patient-care meetings including huddles, case conferencing, and regular service line All Hands
• Provide feedback to improve operational workflows and product features
• Comply with all applicable laws and regulations
• Perform other duties as assigned
• Report to the Director, Virtual Health Assessment

Bilingual Nurse Practitioner – Virtual Health Assessment

Medical Director

• 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 evidence-based research tailored to target populations
• Foster academic partnerships to advance and publish clinical research leveraging health plan population data
• Lead systematic reviews of major specialty society guidelines, including ASCO, ACC, and AACE
• Establish, maintain, and enforce the framework for grading clinical evidence
• Oversee Clinical Advisory Subcommittees by setting agendas, presenting clinical evidence packages, and driving expert consensus
• Partner with Pharmacy Services, Legal, and Compliance to integrate coverage policies meeting NCQA standards and state/federal mandates
• Support interactions with federal and state regulatory bodies, including FDA, CMS, and State DOIs
• Comply with all applicable laws and regulations
• Perform other responsibilities as assigned

Medical Director – Scientific Affairs

Medical Officer

• Serve as the clinical executive for the Atlantic region
• Partner with P&L leadership to lead market performance, expand care access, and enhance affordability
• Optimize medical cost trends and reimbursement strategies
• Execute regional programs and bridge corporate operations with local provider leadership
• Drive key clinical metrics for trend management and regional plan performance
• Identify utilization trends and develop solutions to reduce overall spend
• Build partnerships with health systems, physician groups, and community providers
• Partner with Affordability, Utilization Management, Care Management, Claims, and other internal teams
• Guide clinical initiatives that enhance provider alignment, care quality, and clinical outcomes
• Resolve network gaps and access barriers
• Collaborate with regulatory agencies and compliance teams on network adequacy and quality programs
• Translate policy changes into operational strategy
• Own regional escalations, appeals, grievances, and complex case management scenarios
• Report to the Vice President, Clinical Affairs

Market Medical Officer

• Drive performance of key clinical metrics for regional trend management and market performance
• Partner with Medical Economics to identify utilization trends and develop solutions to reduce overall spend
• Build strategic partnerships with health systems, physician groups, and community providers
• Serve as regional clinical partner with Affordability, Utilization Management, Care Management, Claims, and other internal teams
• Guide clinical initiatives with Network Contracting leadership to enhance provider alignment, care quality, and clinical outcomes
• Identify and resolve regional network gaps and access barriers
• Collaborate with regulatory agencies and compliance teams on network adequacy and quality programs
• Translate policy changes into operational strategy protecting member access and organizational performance
• Own regional escalations, including appeals, grievances, and complex case management scenarios
• Report to the VP of Clinical Affairs
• Perform other responsibilities as assigned

• 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

Associate Medical Director, Regulatory Management

Director

• Develop and advance market strategies that improve growth, performance, and expansion across Oscar's portfolio
• Assess market dynamics, identify opportunities, and build strategies to improve performance and unlock growth
• Lead analyses and support business cases for market expansion, portfolio optimization, strategic partnerships, and segment-specific opportunities
• Translate complex data into clear recommendations for Insurance Product, Finance, Network, and Sales partners
• Transition approved strategies to market teams for execution
• Support market strategies for growth, retention, and performance improvement
• Analyze competitive positioning, regulatory factors, product receptivity, market sizing, and competitor landscapes
• Partner with market leaders to prioritize opportunities and refine local strategic plans
• Support new market entry and expansion analyses and business cases
• Analyze product and market performance to identify optimization and remediation opportunities
• Monitor performance trends across markets and segments
• Develop segment strategies and growth opportunities
• Partner with finance, network, sales, marketing, product, and clinical teams
• Summarize internal, market, and competitive intelligence
• Develop executive-ready materials and narratives for decision-making
• Report to the Vice President, Insurance Product Innovation and Development
• Comply with applicable laws and regulations; perform other duties as assigned

Associate Director, Market Strategy Advisory

Operations

• Perform complex operational work across credentialing, provider data, quality assurance, and analytics
• Evaluate practitioner and facility credentialing records, workflows, source documentation, and system data for accuracy, completeness, timeliness, consistency, and compliance
• Plan and complete risk-based or routine quality audits; select samples, document evidence, score results, identify error patterns, and communicate findings
• Analyze complex datasets using spreadsheets, reporting tools, database queries, or other analytical methods
• Build, maintain, and validate reports, dashboards, metrics, and monitoring controls
• Investigate data anomalies and reconcile information across sources of truth
• Perform root-cause analysis and translate audit results, data trends, and operational insights into corrective and preventive actions, process improvements, and recommendations
• Serve as a credentialing resource on practitioner and facility requirements, including initial credentialing, recredentialing, verification, file review, committee preparation, delegated activities, and provider data dependencies
• Support remediation of complex quality, data, or credentialing issues; track action plans through closure and validate corrective actions
• Coach team members and share subject-matter guidance
• Manage assigned projects, analyses, audits, escalations, and caseloads independently
• Report to the Senior Manager of Provider Operations Credentialing
• Perform other duties as assigned

Senior Analyst, Credentialing Quality & Data Operations

Manager

• Coordinate care across inpatient, outpatient, ER, and home-care settings while maintaining confidentiality and professional standards
• Partner with members and providers to navigate complex health challenges and create personalized care plans
• Assess and address Social Determinants of Health by connecting members with community support resources
• Provide crisis intervention and advocate for members to resolve barriers to care and treatment compliance
• Engage members by phone, secure messaging, or in person to provide education on health conditions, hospital discharges, medical procedures, and prescriptions
• Comply with applicable laws and regulations
• Contribute to process improvement initiatives and new pilot programs
• Report to the Manager, Clinical Programs
• Perform other responsibilities as assigned

Case Manager, CCM

Actuary

• Drive the strategic vision for ACA pricing methodologies.
• Oversee the annual rate filing process with CMS and State DOIs.
• Own significant financial forecasts.
• Deliver executive-level presentations with actionable actuarial recommendations.
• Cultivate strategic partnerships across key business units, including Market P&L and Finance.
• Represent the Actuarial function in executive forums.
• Lead complex analytics initiatives, including morbidity trend and competitive analyses.
• Influence enterprise-wide decisions on pricing, strategic business growth, and network strategies.
• Support federal and state advocacy efforts.
• Author actuarial thought leadership on ACA regulations.
• Provide mentorship, coaching, and development planning for team members.
• Perform other duties as assigned.

Bilingual Nurse Practitioner – Virtual Health Assessment

Medical Director – Scientific Affairs

Market Medical Officer

Market Medical Officer

Associate Medical Director, Regulatory Management

Associate Director, Market Strategy Advisory

Senior Analyst, Credentialing Quality & Data Operations

Case Manager, CCM

Senior Director, Regional Actuarial