Oscar is the first health insurance company built around a full stack technology platform and a 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.

About the role

The Senior Manager works regularly with cross functional leaders to ensure our policy development process is driving affordability goals. You will be responsible for the timely and accurate development of new policies that drive affordability savings in partnership with others. You will oversee a team to ensure our policy guidelines maintain the highest clinical quality standards. The Senior Manager works in partnership with multiple other teams, including pharmacy and medical UM.

You will report to the VP, Clinical Policy.

Work Location:

Oscar is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture and our mission.

If you live within commutable distance to our New York City office (in Hudson Square), our Tempe office (off the 101 at University Dr), or our Los Angeles office (in Marina Del Rey), you will be expected to come into the office at least two days each week. Otherwise, this is a remote / work-from-home role.

You must reside in one of the following states: Alabama, Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, Virginia, Washington, or Washington, D.C. Note, this list of states is subject to change. #LI-Remote

Pay Transparency:

The base pay for this role is: $131,200 - $172,200 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program, and annual performance bonuses.

Responsibilities

Interacts regularly with all levels of management on matters concerning several functional areas, department, and/or customers. Able to propose and work with more senior leaders on forward-thinking goals and roadmaps.
Drives development of new policies from a medical standpoint, works in close partnership with the pharmacy team for pipeline management.
Manage policy development process for both medical and pharmacy. Serve as the accountable party for the accuracy of medical and pharmacy policy research and recommendation as well as accurate incorporation into partner claims organizations (Oscar and external).
Bring industry best practice to policy development process to develop organizational frameworks, templates, process organization, evidentiary source of truth internal references, to create consistency, repeatability, and clear points of interconnectivity between policy organization and other teams. Monitor quality trends and identify gaps to drive quality improvement activities.
Track all deliverables to ensure the organization is meeting SLAs and TAT. Develop SLAs and TAT where needed. Identify and lead process improvement where needed.
Compliance with all applicable laws and regulations
Other duties as assigned

Qualifications

Bachelor's degree in relevant field of study or 4+ years of commensurate experience - PharmD, BSN, or RN required.
6+ years of direct work with clinical policy, with particular emphasis on health insurance policy experience.
5+ years of work experience in utilization management and/or clinical operations
5+ years of experience in designing, implementing and continuously improving programs and processes
5+ years of experience communicating and presenting to stakeholders of all levels
5+ years of experience using Excel and powerpoint
5+ years of experience managing and building a team

Bonus Points

MBA or advanced management degree
Experience working in a fast-paced, collaborative environment
Project management certification
Consulting experience

Travel Required

Up to 10%

This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here.

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.

Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant’s disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known.

California Residents: For information about our collection, use, and disclosure of applicants’ personal information as well as applicants’ rights over their personal information, please see our Notice to Job Applicants.

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