Medical Director Scientific Affairs

• 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.

• 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).

• 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.