Associate Medical Director, Regulatory ManagementActive$216K–$284K
The opportunity
Hi, we're Oscar. We're hiring an Associate Medical Director, Regulatory Management to join our Clinical Affairs team.
What you'll do
Build and lead the Clinical Policy Compliance team and the Clinical Coding: Center of Excellence, driving high-impact compliance, quality, and regulatory strategy across the organization.
Direct the development of clinical regulatory policies, Benefit: Interpretation Policies (BIPs), and operational SOPs to ensure full alignment with state and federal laws, in partnership with other SMEs in the Office of Clinical Affairs.
Chair the Credentialing, Peer Review, and Population Health Management: sub-committee, driving individual case reviews and reporting key performance metrics to quarterly Quality Improvement meetings.
Oversee practitioner and facility credentialing to guarantee compliance with: NCQA standards, CMS requirements, and state regulations - verifying licenses, board certifications, and sanction histories.
Partner with Network and Market Management executives to accelerate provider: onboarding and strategically resolve network gaps while maintaining strict credentialing integrity.
Collaborate on Quality Improvement for Clinical Review Operations, optimizing: Inter-Rater Reliability (IRR) processes, clinical delegate audits, and Potential Quality Issue (PQI) workflows.
What they're looking for
- Identify and resolve operational bottlenecks to streamline processes,: eliminate delays, and enhance member and provider satisfaction without compromising quality or compliance.
- Serve as a subject matter expert on state and federal healthcare regulations,: continuously monitoring legal developments and translating regulatory changes into proactive operational updates to maintain ongoing compliance.
- Compliance with all applicable laws and regulations.
- Other duties as assigned.
