Medical Director, Complex Case Management
Oscar Health Insurance, Tempe, AZ
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What is Oscar?
Oscar is smart, simple health insurance. Oscar is designed to be the entrypoint to the healthcare system for our members. Using easy-to-understand language and a unique set of benefits, we are working to change the way our members think about and interact with health insurance. Our goal is to make health insurance simple, transparent and human.
Oscar's Complex Case Management (CCM) team focuses on caring for our sickest member with chronic medical conditions. The CCM team is made up of clinicians and operations leads who work together to help members access the resources they need. Additionally, they find creative solutions such as addressing social determinants of health and targeted interventions to improve members' quality of care and reduce unnecessary utilization.
As our Medical Director of CCM you will be responsible for overseeing the CCM program. You'll focus on growing the scale and quality of the program, and will provide utilization review for complex members.
What is the position?
We are looking for a Medical Director who is first and foremost an amazing doctor, and is looking to push the envelope on how we deliver care to our sickest members. You'll be working with a team of Field RNs, Social Workers, Community Health Workers, Operations Leads and Concierge Reps to deliver the best and most barrier-free care. You will be reporting to and working with the National Director of Concierge Services specifically on integrating CCM with our other case management and care delivery infrastructure and initiatives. As Oscar launches in Medicare Advantage, you will also be responsible for tailoring our complex and chronic care management towards this new population.
Deliverables: What you have to achieve
- Provide exceptional care over the phone, through messaging, and in-person to support chronic disease management
- Lead clinical escalation meeting and perform utilization review on complex members
- Work with Operational Leads to design and deploy interventions and programs. Use social determinants of health to develop interventions or programs to address the needs of clinically complex members
- Manage a team of In-house and Field RNs, Social Workers and Community Health Workers in multiple regions and provide them with strategic vision
- Reduce overall cost per patient per member through preventions of ER visits and preventable readmissions
- Act as focal point on behalf of CCM to improve operations and coordination with the rest of Care Delivery
- Provide thought leadership and help test new technology and clinical programs
- Work with local regulatory bodies and assist with audits and CAPs
Winning factors: What leads to success
Must-have qualifications and expertise include:
- MD or DO from an accredited medical school
- Board-certification in Internal Medicine, Family Medicine or Emergency Medicine
- Experience delivering virtual care
- Active medical license in Arizona
- 5+ years experience managing an interdisciplinary team (MD, RN, LCSW, etc)
- Willingness to be scrappy! We're still a small company, and that means there's constant change. You need to be comfortable adapting to new workflows, adhering to them, and giving feedback to improve them.
- Technical proficiency - we have a lot of systems we use (Athena, Oscar internal tools) and you need to be comfortable using these tools
- Excited to practice medicine in unconventional ways including delivering more care outside the confines of the usual office visit
- Want to practice in a team-based setting where other clinical and non-clinical team members collaborate to make decisions and care for patients
- Some travel is required to visit regional teams
At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we work to cultivate an environment where exceptional people can be their most authentic selves and find both belonging and support. We're on a mission to change healthcare -- an experience made whole by your unique background and perspectives.
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 (firstname.lastname@example.org) to make the need for an accommodation known.
Pay Transparency Policy: Oscar's Pay Transparency Policy ensures that you won't be discharged or discriminated against based on whether you've inquired about, discussed, or disclosed your pay. Read the full policy here.
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