Utilization Management Liaison Lead

Hi, we're Oscar. We're hiring a Utilization Management Liaison Lead to join our Clinical Review Team Operations.

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

As the Utilization Management (UM) Liaison Lead, you will become an expert on production team workflows to drive goals and key performance indicators for the team of support staff to meet business objectives while providing coaching and leadership. You will partners with team members to manage all appeal levels processed by the UM team and supporting the UM clinicians with post claim clinical review tickets. You will partner with teams to identify and develop workflow improvements to enhance efficiencies for the team.

You will report to the Manager of Utilization Management Processor & Liaison Teams

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 Tempe office (off the 101 at University Dr), we ask you 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, Colorado, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, New Hampshire, New Mexico, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, Virginia, or Washington, D.C. Note, this list of states is subject to change. #LI-Remote

Pay Transparency:

The base pay for this role is $48,960 - $64,260 per year. You are also eligible for employee benefits, participation in Oscar’s unlimited vacation program and annual performance bonuses.

Responsibilities

• Hire and manage a team of Oscar colleagues with direct responsibility for performance management, their growth and development, and associated HR administrative tasks
• Manage your team’s outcomes, monitor dashboards, and track operational KPIs, conducting root-cause analysis and constructing action plans when issues arise 
• Understand and be connected to the type of work your team does daily, being able to make volume-based decisions that best serve our customers. 
• Lead team huddles with Oscar colleagues, connecting colleagues to the mission, vision, and values of Oscar, and providing guidance and motivation to achieve daily operational goals
• Promote team engagement by creating an inclusive and inviting culture that aligns with Oscar’s core values
• Participate in continuous improvement activities that influence the improvement and development of a production team

• Identify and close gaps on existing operational workflows 
• Work collaboratively across production and other Oscar teams to implement best practice

• Compliance with all applicable laws and regulations 
• Other duties as assigned

Qualifications

• 2+ years experience in a customer service environment
• 1+ year of direct people management experience
• 1+ years of experience using data and metrics to guide improvements
• 1+ years of experience working with teams in multiple locations and multiple disciplines

Bonus Points

• Bachelor's degree
• Lean Six Sigma or Process Improvement certification
• Prior healthcare or insurance experience
• Advanced Google Suite or Microsoft Office capabilities
• 2+ years experience solving complex inquiries
• 1+ years managing projects

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.