Medical Director, Clinical Regulatory Affairs

Oscar Health•Atlanta, GA

9d•Remote

About The Position

You will build and oversee the Clinical Policy, Regulatory, and Compliance functions within the Office of Clinical Affairs. You will ensure our clinical operations meet healthcare laws and standards, develop and maintain regulatory policies, manage compliance risks, and guide policy-related submissions. You will advise senior leadership and work closely with teams across the organization to ensure clinical operations align with policy and regulatory intent.

Requirements

Active, unrestricted MD or DO license
10+ years of experience in healthcare or the health insurance industry
5+ years of experience in clinical policy compliance or clinical regulatory/government affairs
5+ years applying state and federal health insurance laws and regulations (Marketplace, MA, reporting, and audit requirements)
5+ years preparing and presenting reports to boards of directors
5+ year of team leadership and people development experience

Nice To Haves

JD or other legal training/certification
Experience with ACA or commercial health plans
Experience working in a fast-paced, collaborative environment

Responsibilities

Lead and grow the Clinical Policy & Regulatory Affairs team.
Build and manage processes that ensure clinical policy compliance and quality.
Develop and maintain BIPs, SOPs, and other clinical policy documents aligned with QMS.
Serve as a regulatory compliance expert and maintain strong relationships with key clinical teams.
Deliver executive briefings on regulatory and policy impacts.
Advise the CMO and senior leaders on compliance risks and strategy.
Support interactions with federal and state regulators (FDA, CMS, state DOI).
Oversee the Clinical Coding Center of Excellence and clinical credentialing.
Promote a culture of compliance through training and education.
Collaborate effectively with stakeholders across the organization.