Medical Director Scientific Affairs

About the role:

Responsibilities:

• Serve as the primary evidence-based subject matter expert, translating clinical research into actionable strategies to elevate care quality across the organization.
• Lead the research, development, revision, and clinical accuracy of all medical, utilization management (UM), and pharmacy coverage policies.
• Advise executive leadership on emerging medical therapies, complex clinical trends, and population health utilization patterns using data-driven insights.
• Support the development of clinical and lifestyle products through the production of evidence based research tailored to target populations.
• Foster academic partnerships to advance and publish clinical research leveraging health plan population data.
• Lead the systematic review of major specialty society guidelines (e.g., ASCO, ACC, AACE), ensuring policies reflect established standards of care and objective evidence evaluation.
• Establish, maintain, and enforce the formal framework for grading clinical evidence, ensuring all medical and pharmacy policies are anchored in high-quality, peer-reviewed literature.
• Oversee Clinical Advisory Subcommittees - setting agendas, presenting clinical evidence packages, and driving expert consensus to guide policy decisions.
• Partner with Pharmacy Services (P&T Committee), Legal, and Compliance to seamlessly integrate coverage policies that meet or exceed NCQA standards and state/federal mandates.
• Support interactions with federal and state regulatory bodies (e.g., FDA, CMS, State DOIs) as needed.
• Compliance with all applicable laws and regulations.
• Other responsibilities as assigned.

Requirements:

• 10+ years working in relevant fields
• 6+ years clinical policy experience in health insurance, PBM, or other clinical guideline development organization
• 4+ years experience in clinical policy drafting and development
• 4+ Years of experience leading, chairing, or facilitating multi-disciplinary clinical committees or advisory subcommittees
• 4+ years publishing in relevant fields
• 3+ years of experience communicating with executives and interacting with all levels of the organization
• 3+ years of leadership experience as a people manager
• 1+ years of experience with medical coding terminologies (HCPCs, CPT, ICD-10)
• Medical Degree (MD or DO): Required from an accredited school of medicine or osteopathic medicine
• Board Certification: Active board certification recognized by the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA).
• Bonus points:
• Demonstrated experience analyzing clinical trials and medical literature.
• A track record of publishing in peer-reviewed clinical journals or serving on an Institutional Review Board (IRB) or Clinical Practice Guideline panel is highly desirable
• PhD or Masters in Clinical Research
• This is an authentic Oscar Health job 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.
• Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.
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