Hi, were Oscar. Were a fully licensed health insurer. Our goal is to make healthcare simple, transparent, & human.
We are changing how health insurance works by creating a healthcare experience thats intuitive & puts people, not cost or workflows, first. Were using a consumer-focused & tech-driven approach to do so. This positions us uniquely in the space - & creates one of the biggest opportunities in healthcare.
We brought together leaders from top technology, service & healthcare companies to deliver on our promise & seize this opportunity. We all work side by side in a collaborative, energetic, & creative environment. The result: better people, better ideas, & better healthcare.
In this role, you will play an essential role in launching our Medicare Advantage business. The Clinical Review team is one of Oscars most important clinical functions - we encourage evidence-based practice through utilization review to ensure our members get access to the right care - particularly those who need it most. You will be responsible for understanding & helping to operationalize our regulatory requirements in our new Medicare Advantage business.
This is an exciting opportunity to be at the forefront of growth at Oscar, helping enable our innovative model reach new members.
What is the position?
Here at Oscar, we move quickly & are perpetually introducing new ideas. We need you not only to be able to think analytically & strategically, but, just as important, to execute on those ideas.
During your first six weeks, you should have:
- Developed an in depth understanding of the regulatory requirements for our Medicare Advantage business
- Developed an in-depth understanding of our clinical review Medicare Advantage workflows & data
- Begun to independently respond to escalated issues requiring analysis
- Begun to develop working relationships with key internal stakeholders (Compliance, Legal, Quality, Ops, & Tech functions)
- Begun to become a critical source of support for the rest of the Clinical Review Medicare Advantage team
Afterwards & on an ongoing basis, you will:
- Serve as project manager for the team during CMS audits
- Ensure the clinical review team is compliant to all Medicare Advantage regulations
- Support the annual CMS application process
- Help the clinical review team prepare for expansion into new markets
- Manage the development & maintenance of policies & procedures
- Work with your operational colleagues & the clinicians to deliver on continuous process improvement, from identifying pain points & needs to developing & implementing solutions
Winning factors: What leads to success
Were looking for someone with 3-5 or more years of work experience. Must-have qualifications & expertise include:
- Acute attention to detail
- Structured/analytical thinking & problem-solving skills
- Ability to break down complex processes & communicate them & your ideas simply & clearly
- A curious mind & innate passion for making things work better
- Interest in legal regulations & how they translate to operations
- Experience in healthcare (Medicare Advantage experience preferred)
We think it will make a big (positive) difference if you have:
- A bachelor's or nursing degree
- Regulatory or compliance experience
- Experience working in a fast-moving, collaborative environment
At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we work to cultivate an environment where exceptional people can be their most authentic selves & find both belonging & support. We're on a mission to change healthcare -- an experience made whole by your unique background & perspectives.