Associate, Medical Policy Development

Hi, we're Oscar. We're hiring an Associate, Medical Policy Development 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

The Associate helps develop and review our medical policies, aligning with the fast pace of changes in medical literature and standards. You take the lead in drafting, obtaining approval, and maintaining medical policies based on current clinical evidence and nationally-recognized standards.

You will report to the Manager, Medical Policy Development.

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: $98,400 - $129,150 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program, and annual performance bonuses.

Responsibilities

• Track edits, amendments, evidence submissions and feedback in accordance with policy team's operational standards
• Develop an in-depth understanding of regulatory and quality requirements applicable to our programs
• Track evidence submissions and feedback on policies, and prioritize policy updates
• Ensue 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

Qualifications

• Active, unrestricted RN (BSN preferred) license
• 3+ years of clinical research, policy development, medical writing, quality auditing, claims/payment integrity auditing, or utilization management review
• 3+ years of experiencing using Excel
• 3+ years of experience communicating, both written and verbally, with stakeholders at all levels
• 3+ years of experience solving complex problems

Bonus Points

• Medical coding experience and/or certification
• Experience with MCG criteria
• Regulatory or compliance experience
• Experience working in a fast-paced, collaborative environment

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.