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Oscar Health // health insurance
 
New York City    Posted: Tuesday, December 29, 2020
 
   
 
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JOB DETAILS
 

Hi, we're Oscar. Were hiring a Director of Quality Improvement to join our Business Operations team.

Oscar is a technology-driven, consumer-focused health insurance startup founded in 2012 & headquartered in New York City. Our goal is to make health insurance simple, transparent, & human. We need your help to do so.

About the role:

This position oversees the Quality Improvement (QI) team for the Oscar health plans. This role leads the QI program structure & methodology including the facilitation of quality committees across multiple departments. The QI team oversees the end to end NCQA health plan accreditation survey process. The role manages a team of clinical reviewers & coordinators to conduct quality of care reviews & escalation to Peer Review. In addition, this role represents QI leadership & strategy for internal & external stakeholders & business projects.

You will report into the National Medical Director, Clinical Review.

Responsibilities:

  • Designs, leads & directs  the Quality Improvement/Management Program for the commercial & Medicare Advantage health plan products with the goal of improving the health outcomes & experience of members nationwide.
  • Partner with clinical & business leaders to set strategic goals & long term plans for quality improvement & patient safety initiatives across the company.
  • Build & execute a long term strategy for NCQA health plan accreditation,  ongoing adherence monitoring & budgeting. 
  • Oversees the quality of care & peer review programs setup to assure processes meet compliance & quality requirements. Monitor potential issues & work with system providers to correct issues & improve overall quality.
  • Serve as the subject matter expert & drive key improvement initiatives across teams through matrix & project management.
  • Interpret, disseminate & operationalize quality goals, accreditation standards & regulatory requirements. Work directly with compliance & legal leadership to strategically address business growth & remain compliant. 
  • Facilitate internal quality committees & develop key reports & insights for QI committees, regulators, & Board Members.
  • Act as a thought leader & collaborator reporting to the VP of Clinical Operations & to find innovative solutions to complex problems with the goal of having happier & healthier members.
  • Represent Oscar quality leadership in external audits/relationships with NCQA, state regulators, CMS, exchange administrators, C+O,  & network partners. 
  • Accountable for the performance & development of several work teams within the department. Manages budget planning & scalable staff modeling & growth.

Requirements:

  • 5 + years experience managing NCQA Health Plan Accreditation surveying & monitoring
  • 10+ years quality operations experience.  
  • Bachelors in Public health, health administration, health policy or science or commensurate experience

Bonus points:

  • Knowledge of CMS quality improvement strategy, DMHC, etc. 
  • Professional quality certification such as CPHQ
  • Master degree

Life at Oscar: 

Our more than 1,000 employees aim to make health care affordable & accessible for all. We apply this same vision to our perks & benefits, including: medical benefits, generous paid-time off, paid parental leave, retirement plans, company social events, stocked kitchens, wellness programs, & volunteer opportunities.

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 & find both belonging & support. We're on a mission to change health care -- an experience made whole by your unique background & perspectives.

Reasonable Accommodation

Oscar applicants are considered solely based on their qualifications, without regard to applicants 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.

Pay Transparency Policy

Oscar ensures that you won't be discharged or discriminated against based on whether you've inquired about, discussed, or disclosed your pay. Read the full policy here.

 
 
 
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