Oscar Health
About the role
You will be a key member on our Clinical Policy team within the Office of Clinical Affairs (OCA). You will work with cross‑functional leaders to ensure our policy process supports affordability goals, identify policy‑driven opportunities for Medical and Rx affordability savings, perform competitor policy gap analyses, analyze policy code level performance data, track policy trends and hotspots, and identify policy pathway opportunities. You will monitor policy performance and partner with other teams to implement process changes that drive affordability outcomes and improve efficiency. You will report to the Senior Manager, Clinical 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. This is a hybrid role in our New York City office. You will work part of the time in the office and part of the time remote / work‑from‑home. 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
Track policy performance, identify areas for process changes or optimization to drive both affordability and efficiency goals. Accountable for suspecting multiple opportunities to bring forward for further evaluation. Develop internal tracking and monitoring necessary for organizing multiple projects along multiple timelines and deliverables. Ensure policy opportunities are appropriately tracked and managed through our policy opportunity pipeline. Assess policy structures to identify functionally unnecessary components, enabling streamlined policy design and implementation. Create evidence‑based recommendations for policy modifications, including appropriate loosening, tightening, or re‑routing for additional review. Incorporate data to drive further iteration and improvement. Bring industry best practices to the policy optimization process to develop organizational frameworks, templates, process organization, and clear points of interconnectivity between policy organization and other teams. Maintain current knowledge of industry best practices in the space, and work to drive innovation and new approaches. Perform in‑depth review of integrated claims and operational data (medical, pharmacy, lab, auths) to identify cost and trend drivers informing the clinical policy development pipeline. Build processes that scale across therapeutic areas. Create executive‑ready visualizations tailored to different stakeholder audiences (clinical vs. financial). Maintain strong relationships, rapport, and lines of communication with stakeholders. Compliance with all applicable laws and regulations. Other duties as assigned. Qualifications
Bachelor\'s degree (minimum) in relevant field of study or 4+ years of commensurate experience — B.S.Pharm, PharmD, PA, NP, APRN, BSN, or RN required. Active, unrestricted clinical license. 4+ years of direct work with clinical policy, with particular emphasis on health insurance policy experience. 4+ years of work experience in utilization management and/or clinical operations. 3+ years of experience in designing, implementing and continuously improving programs and processes. 3+ years of experience communicating and presenting to stakeholders of all levels. 2+ years of experience using Excel/Google Sheets and PowerPoint/Google Slides. Working knowledge of medical coding (e.g. CPT, ICD‑10, HCPCS) and claims and/or working knowledge of pharmacy coding (e.g., GPI, GSN/CGN, NDC) and claims. Bonus points
MBA or advanced management degree Experience with commercial or ACA insurance. Prior work experience analyzing and modeling clinical policy outcomes. Prior work experience in health insurance and matrixed organizations supporting multiple stakeholders. Experience translating between clinical and business vocabularies. Project management certification Consulting experience Equal Opportunity Employer : Oscar Health is an Equal Opportunity Employer. We cultivate an environment where people can be their most authentic selves and find belonging and support. We are on a mission to change health care with diverse 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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You will be a key member on our Clinical Policy team within the Office of Clinical Affairs (OCA). You will work with cross‑functional leaders to ensure our policy process supports affordability goals, identify policy‑driven opportunities for Medical and Rx affordability savings, perform competitor policy gap analyses, analyze policy code level performance data, track policy trends and hotspots, and identify policy pathway opportunities. You will monitor policy performance and partner with other teams to implement process changes that drive affordability outcomes and improve efficiency. You will report to the Senior Manager, Clinical 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. This is a hybrid role in our New York City office. You will work part of the time in the office and part of the time remote / work‑from‑home. 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
Track policy performance, identify areas for process changes or optimization to drive both affordability and efficiency goals. Accountable for suspecting multiple opportunities to bring forward for further evaluation. Develop internal tracking and monitoring necessary for organizing multiple projects along multiple timelines and deliverables. Ensure policy opportunities are appropriately tracked and managed through our policy opportunity pipeline. Assess policy structures to identify functionally unnecessary components, enabling streamlined policy design and implementation. Create evidence‑based recommendations for policy modifications, including appropriate loosening, tightening, or re‑routing for additional review. Incorporate data to drive further iteration and improvement. Bring industry best practices to the policy optimization process to develop organizational frameworks, templates, process organization, and clear points of interconnectivity between policy organization and other teams. Maintain current knowledge of industry best practices in the space, and work to drive innovation and new approaches. Perform in‑depth review of integrated claims and operational data (medical, pharmacy, lab, auths) to identify cost and trend drivers informing the clinical policy development pipeline. Build processes that scale across therapeutic areas. Create executive‑ready visualizations tailored to different stakeholder audiences (clinical vs. financial). Maintain strong relationships, rapport, and lines of communication with stakeholders. Compliance with all applicable laws and regulations. Other duties as assigned. Qualifications
Bachelor\'s degree (minimum) in relevant field of study or 4+ years of commensurate experience — B.S.Pharm, PharmD, PA, NP, APRN, BSN, or RN required. Active, unrestricted clinical license. 4+ years of direct work with clinical policy, with particular emphasis on health insurance policy experience. 4+ years of work experience in utilization management and/or clinical operations. 3+ years of experience in designing, implementing and continuously improving programs and processes. 3+ years of experience communicating and presenting to stakeholders of all levels. 2+ years of experience using Excel/Google Sheets and PowerPoint/Google Slides. Working knowledge of medical coding (e.g. CPT, ICD‑10, HCPCS) and claims and/or working knowledge of pharmacy coding (e.g., GPI, GSN/CGN, NDC) and claims. Bonus points
MBA or advanced management degree Experience with commercial or ACA insurance. Prior work experience analyzing and modeling clinical policy outcomes. Prior work experience in health insurance and matrixed organizations supporting multiple stakeholders. Experience translating between clinical and business vocabularies. Project management certification Consulting experience Equal Opportunity Employer : Oscar Health is an Equal Opportunity Employer. We cultivate an environment where people can be their most authentic selves and find belonging and support. We are on a mission to change health care with diverse 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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