Manager, Vendor Clinical Policy

Job Description

Job Description

Hi, we're Oscar. We're hiring a Manager, Vendor Clinical Policy to join our Clinical Policy team.

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 :

You will be a key member on our Clinical Policy team within the Office of Clinical Affairs (OCA). You will work regularly with cross-functional leaders to ensure our vended policy sets are driving affordability and clinical quality goals. You will oversee the clinical assessment of the policies themselves ensuring accuracy, and validating the vendor's process of development, maintenance, and implementation.

You will report to the Senior Manager, Clinical Policy Development.

Work Location : This is a remote position, open to candidates who reside in : Atlanta, Georgia. You will be fully remote; however, our approach to work may adapt over time. Future models could potentially involve a hybrid presence at the hub office associated with your metro area. #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 :

• Clinically evaluate vendor policy sets to ensure their development, and criteria meet internal and external standards for our medical policy, referencing standards of care, third-party criteria, and other sources.
• Vet newly identified vendor policy sets for affordability opportunities taking into account various factors, including, but not limited to, policy & clinical departmental strategy & goals, and organizational strategy & goals.
• Ensure vendor policy and processes are streamlined, standardized, and adhere to larger departmental strategy.
• Work with cross functional partners to support affordability initiatives involving other types of policy from a clinical standpoint and by using subject matter expertise and business acumen to advise and provide recommendations across the organization.
• Support areas of efficiency improvement, including in-housing analyses or projects.
• Track all deliverables to ensure we are meeting SLAs and TAT. Develop SLAs and TAT where needed.
• Prepare and present all materials for executive external view and feedback. Summarize changes and track evolution of vendor policy changes to support audit functions.
• Responsible for high-complexity reviews that require extensive up-to-date industry expertise or contextual knowledge.
• Develop an in-depth understanding of regulatory and quality requirements applicable to our programs.
• Ensure processes and documentation are in place and in compliance with State, Federal and NCQA requirements.
• Provide support on regulatory audits and quality accreditation surveys, as needed.
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements :

Bonus points :

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.

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