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About the Role
The Behavioral Health Medical Director oversees behavioral health services across Oscar / +Oscar plans by collaborating closely with internal teams and external vendors. This role ensures that utilization management, case management, and quality improvement programs meet all state, federal, and accreditation standards. The Behavioral Health Medical Director drives clinical, financial, and operational performance to continuously optimize behavioral health outcomes across the plan.
Responsibilities
- Participate in the implementation, supervision, evaluation, and oversight of the behavioral health aspects of Oscar's utilization management program, including developing a strong working relationship with key regulators and accrediting bodies, and represent Oscar externally in behavioral health clinical matters and audits where applicable.
- Provide clinical determinations based on evidence-based criteria and Oscar internal guidelines and policies, while utilizing your clinical acumen.
- Conduct timely evaluations of escalated cases, including initial denials, peer-to-peers (including giving feedback on alternate treatment based on medical necessity criteria and evidence-based research) and first-level appeals, within required turnaround times. Clearly and accurately document all communication and decision-making in Oscar workflow tools, ensuring a member could easily reference and understand decisions.
- Maintain oversight for quality improvement and medical management services pertaining to behavioral health at Oscar, including participation in relevant committees and sub-committees of the Quality Improvement (QI) program.
- Support oversight of behavioral health vendors, including quality assurance of delegated functions, when applicable.
- Compliance with all applicable laws and regulations.
- Other duties as assigned.
Requirements
- 3+ years of clinical practice as a psychiatrist.
- MD or DO with a current unrestricted license to practice medicine in the US, and willing to obtain additional state licenses with Oscar's support.
- Board certified in Psychiatry
- Medical licensure in Florida, or IMLCC-eligible
- 1+ years of behavioral health managed care, utilization review or equivalent experience.
- Licensure in multiple additional Oscar states preferred but not required (AZ, NC are highly desirable).
- Experience with behavioral health care management.
- Experience in a startup: understanding the pace and culture.
Location
- Remote (US, excluding AK, DE, HI, LA, MT, ND, OK, WV, WY, and US Territories)
Work Type
- Fully remote
- Occasional travel required
Experience Level
- 3+ years of clinical practice
- 1+ years of behavioral health managed care, utilization review or equivalent experience
Education Level
- MD or DO
Salary/Compensations
- $130-$145 per hour
Benefits
- Medical benefits
- Dental benefits
- Vision benefits
- 11 paid holidays
- Paid sick time
- Paid parental leave
- 401(k) plan participation
- Life insurance
- Disability insurance
- Paid wellness time and reimbursements
About the Company
- 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.
Equal Opportunity
- 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.
- Oscar applicants are considered solely based on their qualifications, without regard to applicant’s disability or need for accommodation.
- 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.