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Arizona Medical Director

Oscar, Tempe, AZ

A better kind of health insurance company


In this position you will lead the clinical concierge organization in shaping and delivering the clinical vision for the Oscar Concierge Team. Reporting to Oscar’s Senior Medical Director of Care Delivery, and working in partnership with Oscar’s Senior Director of Member Services, you’ll lead the clinical function of the Concierge vision. This is a unique opportunity for a forward-thinking clinician to play a crucial role directing an innovative part of their organization.

Based at their Health Hub in Tempe, AZ, you will be working closely with leaders across all member facing services to develop how their Concierge model can drive a differentiated healthcare experience for their members. With their sizeable membership growth, the Hub has been the fastest growing part of their organization. As they continue to grow within existing markets and enter new states, you will be a critical voice in their overall Care Delivery growth strategy.

Roles and Responsibilities:

Clinical Leadership

Escalations

·       Provide clinical guidance for escalations

·       Continue to refine escalation pathways

·       Identify escalation trends and work cross-functionally to solve (i.e. with Network)

Case and Care Management

·       Work with Population Health to operationalize MLR driven interventions

·       Continue to develop chronic care and disease management strategy

·       Monitor case management activity across teams and regions; work with operations counterpart to load balance as needed

Complex Case Management (CCM)

·       Work with CCM medical director and team to integrate workflows with Tempe case management teams

Regulatory

·       Ensure clinical activity in compliance with state and federal regulatory agencies

·       Implementing CAPs as needed

Cross Functional

Internal

·       Developing closer relationship between Case Management nurses and Utilization Management nurses

·       Managing syncs and escalations with other Oscar departments i.e. Network, Quality/Compliance, Product/Engineering

·       Staying connected with leadership i.e. other state medical directors, HQ

·       Working with Non-Clinical Operations to drive continuous operational improvements to improve quality and scale

External

·       Managing case management relationships with vendors i.e. transplant, behavioral health, DME

·       Identifying and escalating gaps in our network i.e. home health, post-acute

·       Working with system partners to identify and implement opportunities to improve continuity of care

People and Workforce Management

·       Scaling and managing a large clinical organization

·       Identify and address functional gaps i.e. rolling out social worker strategy

·       Ensuring clinical teams are working at the top of their license

·       Creating a culture of growth and success for the entire health hub (clinical and non-clinical)

·       Continue to build management team and work with dyad partners to achieve all of the above

About Oscar

Founded in 2012, Oscar is probably the last thing you would expect from a technology startup – a seemingly old-fashioned healthcare insurance provider. The company provides clients with the kind of clarity and simplicity we have come to expect from an e-commerce site. And, of course, they're hiring.


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