Medical Director, Complex Case Management

  • Oscar
  • Remote
  • Apr 21, 2022
Physician Emergency Medicine Family Medicine General Surgery Internal Medicine

Job Description

Hi, we're Oscar. We're hiring a Medical Director of Complex Case Management to join our Member Care & Services Team.

Oscar is the first health insurance company built around a full stack technology platform and a 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.

About the role:

As the Medical Director of Complex Case Management this role will be responsible for overseeing the CCM program, focusing on growing the scale and quality of the program and providing utilization review for Oscar’s complex members. 

Primary Duties and Responsibilities:

  • Provide exceptional care over the phone, through messaging to support chronic disease management
  • Lead clinical escalation meeting 
  • 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 preventing ER visits and 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 NCQA audit and meetings. 

 

Required education and experience

  • Licensure: Board certification or eligibility as an MD or DO with a current unrestricted license to practice medicine. Willing to obtain additional state licenses, with Oscar's support. Reviewers must maintain necessary credentials to retain the position.
  • 3+ years clinical practice in one of the following fields: internal medicine, family medicine, general surgery, emergency medicine.
  • Experience with Complex Case Management or Complex patients
  • 2+ years experience managing an interdisciplinary team (RN, SW, CHW, etc)
  • Proven success using data to drive outcomes
  • Technical proficiency - we use a lot of systems (Athena, Oscar internal tools) and you need to be comfortable using these tools

 

This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here

Life at Oscar: 

At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.

We aim to make health care affordable and accessible for all, and apply this same vision to our perks and benefits, including: medical benefits, generous paid-time off, paid parental leave, retirement plans, company social events, stocked kitchens, wellness programs, and volunteer opportunities.

Pay Transparency Policy:

Oscar 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.

Reasonable Accommodation:

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 (accommodations@hioscar.com) to make the need for an accommodation known.

To protect the health and safety of our employees, we require any employee conducting in-person work* to be fully vaccinated against COVID-19 by their start date. If you are unable to be vaccinated due to medical or protected religious reasons, please reach out to our Benefits team at accommodations@hioscar.com to submit an accommodations request.

*Note: In-person work includes: employees required to work from our offices, employees conducting sales work in the field and employees conducting at-home or in-person visits with members.