Associate, Medical Policy Development
Remote
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 …
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RestrictionsArizona California Colorado Connecticut Florida Georgia Illinois In-office work required for local residents Iowa Kentucky Maine Maryland Massachusetts Michigan Minnesota Missouri Must reside in one of the following states Must reside in specified states Nevada New Hampshire New Jersey New Mexico New York North Carolina Ohio Oregon Pennsylvania Rhode Island South Carolina Tennessee Texas Utah Vermont Virginia Washington
Benefits/Perks11 paid holidays Annual performance bonuses Dental Disability Insurance Employee benefits Life and Disability insurance Medical Medical, dental, and vision benefits Paid holidays Paid parental leave Paid sick time Paid wellness time Paid wellness time and reimbursements Performance bonuses Unlimited Vacation Unlimited vacation program Vision Vision Benefits
Tasks- Compliance
- Compliance with all applicable laws and regulations
- Maintain compliance with regulations
- Other duties as assigned
Auditing C Claims auditing Clinical Clinical Policy Clinical Research Coding Communication Compliance Documentation Excel Health Insurance Management Medical Coding Medical Writing Policy Development Problem-solving Quality Auditing Regulatory Regulatory Compliance Technology Technology Platform Utilization management
Experience3 years
Education