Hi, we're Oscar. We're hiring a Manager, Medical Policy to join our Medical Policy team.

Oscar is the first health insurance company built around a full stack technology platform & a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselvesone that behaves like a doctor in the family.

About the role:

You will lead the clinical research & development of evidence-based medical necessity criteria within the Office of Clinical Affairs (OCA). You will be responsible for the end-to-end clinical lifecycle of medical policies, ensuring that coverage criteria for medical services, devices & technologies are supported by current clinical literature & nationally recognized standards. You will serve as the lead clinical subject matter expert (SME) for medical evidence appraisal, ensuring our clinical policies are evidence-based, compliant, & supportive of optimal health outcomes for Plan members.

You will report into the Associate Director, Clinical Policy - Affordability.

Work Location: This is a remote position, open to candidates who reside in: Atlanta, GA. You will be fully remote; however, our approach to work may adapt over time. Future models could potentially involve a hybrid presence at the hub office associated with your metro area. #LI-Remote

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 & annual performance bonuses.

Responsibilities:

• Lead the review of clinical literature, regulating agency guidance (e.g., FDA, CMS, State/Federal Departments), & specialty society guidelines to develop sound coverage criteria for medical services, devices & technologies.
• Conduct & manage health technology assessments for novel medical technologies & complex devices.
• Coordinate with internal & external specialty-matching physicians for the clinical review & validation of medical policies.
• Translate complex clinical data & evidence-based recommendations into precise, defensible medical necessity criteria & clinical positions or guidance.
• Own the end-to-end drafting & maintenance of the medical policy library, ensuring language is clinically accurate, unambiguous, & operationally interpretable.
• Responsible for the preparation & presentation of evidence-based medical policies & summaries of changes to the Clinical Advisory Subcommittee (CAS) & internal forums.
• Oversee, onboard, develop, & manage a team of clinical FTEs, contractors, & matrixed reports.
• Ensure all clinical policy development processes are streamlined & align with the larger departmental & Office of Clinical Affairs (OCA) strategy.
• Ensure clinical policy development processes & documentation comply with State, Federal, & NCQA requirements.
• Provide support on regulatory audits & quality accreditation surveys as needed.
• Compliance with all applicable laws & regulations
• Other duties as assigned

Requirements:

• Graduate degree in Healthcare Administration, Public Health, Health Policy, Health Services Research, Epidemiology, or a closely related discipline (such as Nursing or another allied health field).
• 58 years in healthcare, with 35 years specifically focused on medical policy development, clinical research, or medical writing.
• Experience in people leadership, including the ability to manage, mentor, & develop clinical professionals.
• Proficiency in leveraging clinical databases (e.g., PubMed) to conduct literature reviews, evaluate evidence, & synthesize findings into defensible medical necessity criteria or recommendations.
• Expert ability to interpret complex clinical data & conduct health technology assessments to determine medical coverage standards.

Bonus points:

• Active, unrestricted clinical license (e.g., RN, NP, PA).
• Working knowledge of medical coding (e.g. CPT, ICD-10, HCPCS) & claims.
• 2+ years of experience using Excel/Google Sheets & PowerPoint/Google Slides.
• Ability to translate technical clinical evidence for both clinical & non-clinical stakeholders.
• Experience with Managed Care regulatory requirements, NCQA standards, & ACA marketplace rules.
• Background in managed care, utilization management, or evidence-based clinical guideline development.
• Experience in fast-paced, tech-enabled environments with complex cross-functional stakeholder management.