Oscar Health: Associate Medical Director, Regulatory Management — Remote

About Oscar Health

Oscar Health is a health-insurance business built around a technology platform and member services. Its recruitment board also describes Oscar Medical Group activities in virtual health assessments and virtual care. Those notices reflect distinct parts of the wider operation: insurance products and member administration alongside clinical services. Technology, insurance operations and care delivery consequently appear in different roles on the board, with the employing team determining the service and professional responsibilities of an individual position.

The position and its setting

Oscar Health lists Associate Medical Director, Regulatory Management in Remote, under reference 8193728. The details below separate the work described by the employer from essential conditions, preferred experience and practical preparation advice.

• Department: Clinical
• Employer listing date: 15 September 2026

Responsibilities and work described

• Building: 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
• Collaboration: on Quality Improvement for Clinical Review Operations, optimizing Inter-Rater Reliability (IRR) processes, clinical delegate audits, and Potential Quality Issue (PQI) workflows
• 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

Essential requirements and candidate background

• 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
• Knowledge: provider data management, credentialing systems, and primary source verification processes
• Ability to lead teams, manage competing priorities, and lead measurable operational results
• Education:
• MD or DO with a current unrestricted license to practice medicine is required
• License and Certification:
• Reviewers must maintain necessary credentials to retain the position including maintaining active board certification
• Willing to obtain additional state licensure (with Oscar's support)

Education and qualification routes

• Degree / qualification: Masters degree or advanced certificate

Preferred experience and additional strengths

• Licensure in multiple Oscar states
• Prior experience with Utilization management
• This is an authentic Oscar Health job opportunity
• 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
• 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

Location, schedule and contract conditions

For this overseas or regional listing, confirm work authorisation and any location restrictions with the employer. The location does not establish visa sponsorship or permission to work remotely from India.

• 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
• Daily work is completed from your home office, with occasional travel required for team meetings and company events. #LI-Remote
• Work arrangement: Remote
• Advertised location: Remote

Pay and application dates

A verified salary figure is not established in this article. An online estimate for another Associate Medical Director, Regulatory Management vacancy is not an offer for reference 8193728; use the employer’s own pay disclosure and recruitment communication.

A closing date is not confirmed in this article. Check the current employer page before submitting: an undated posting can change or be withdrawn.

How to apply to Oscar Health

Applications follow the official employer page linked below.

Open the official Oscar Health posting below and match the title and reference 8193728.

Compare your qualifications and experience with the essential conditions for the Remote position, then read the preferred criteria separately.

Prepare an accurate CV and the supporting items requested in that employer’s application. Provide only information and documents you are authorised to share.

Use the employer’s application option, complete the required fields and review the submission. Retain the acknowledgement when one is provided. Job Alerts World does not receive the application.

Practical preparation: AI

An AI-related example should make the task and evaluation explicit. Explain the inputs, the system’s intended output and how you checked errors, usefulness or reliability, rather than relying on the model name alone.

Relevant skills

• AI/ML
• AI
• process improvement
• audit
• compliance
• insurance
• partnership development
• credentialing