Sr. Manager, UM Authorization Strategy

Hi, we're Oscar. We're hiring a Sr. Manager, UM Authorization Strategy to join our 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 work within our Clinical Business Operations, you will work with our clinical and non clinical teams to further drive the success of Oscar's UM Operations. You will work with our Utilization Management teams to define and operationalize our Prior Authorization strategy to improve the program ROI. You will manage the source of truth and monitor the performance of our auth strategy.

You will report to the Director, UM Authorization Strategy.

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, Arkansas, 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 in the states of California, Connecticut, New Jersey, New York, and Washington is: $131,200 - $172,200 per year. The base pay for this role in all other locations is: $118,080 - $154,980 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.

Responsibilities

• Improve the UM program's ROI by defining the prior authorization strategy.
• Identify success criteria, and implement operating metrics to measure success; analyze data to own root cause analysis and implement mitigation strategies.
• Evaluate data to drive performance improvement and create dashboards for Senior Leadership report outs.
• Partner with Data Science and clinical teams to understand current utilization trends and identify opportunities to bend the cost curve.
• Work with the clinical policy team to make sure there is alignment between clinical policy and prior authorization strategy.
• Program management of key department and cross functional strategy initiatives.
• Build operating playbooks and workflows to get the most value out of department initiatives.
• Compliance with all applicable laws and regulations.
• Other duties as assigned.

Qualifications

• 6+ years experience in strategy and operations.
• 4+ years project planning and program management experience.
• Expertise in working with data and making data backed decisions

Bonus Points

• Master's degree.
• 6+ years experience working in healthcare or insurance industries in a strategy, business development, or project management role.
• Experience in prior authorization strategy vertical with a payer.
• Clinical experience.

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.