Hi, we're Oscar. Were hiring a Pharmacist to join our Clinical Review team in our New York office.
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:
In this role, you will play an essential role in improving the quality of decision-making for our utilization management function. 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 grow our clinical policy program & driving quality improvement initiatives.
- Drafting pharmaceutical policies based on current clinical evidence & nationally-recognized standards
- Tracking evidence submissions & feedback on policies
- Support training & remediation
- Learning & using Oscar tools & processes to perform & properly track audits
- Developing, administering, scoring, & reporting on UM interrater reliability tests
- Auditing our UM clinical decision-making, criteria application, & documentation
- Auditing our UM delegate decision-making, criteria application, & documentation
- Supporting clinical leaders in disseminating feedback & conducting remediation
- Monitoring quality trends & identifying gaps to drive quality improvement activities
- Developing an in-depth understanding of regulatory & quality requirements applicable to our programs
- Ensuring processes & documentation are in place & in compliance with State, Federal & NCQA requirements
- Providing support on regulatory audits & quality accreditation surveys, as needed
Winning factors: What leads to success
Were looking for someone with 5+ or more years of work experience. Must-have qualifications & expertise include:
- Active, unrestricted pharmacist license
- 2-3 years of performing pharmacy reviews for a managed care plan
- Experience conducting UM audits and/or administering inter-rater reliability tests
- Experience with clinical research, policy development, and/or medical writing
- A track record for strong, evidence-based clinical decision-making
- A passion for improving clinical decision-making & providing feedback to help people improve
- Acute attention to detail
- Strong problem-solving skills & comfortable with technology
- Excited about building tools & thinking outside the box
We think it will make a big (positive) difference if you have:
- PharmD degree
- Experience working with the CVS portal & criteria, or with MCG
- Experience building or leading a quality audit & inter-rater reliability program
- Experience working in a fast-paced, collaborative environment
- Excellent written & verbal communication skills
Life at Oscar:
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 our unique backgrounds & perspectives.
We encourage our members to care for their whole selves, & we encourage our employees to do the same with comprehensive medical benefits, generous paid-time off, paid parental leave, retirement plans, company social events, stocked kitchens, wellness programs, & volunteer opportunities.
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 (firstname.lastname@example.org) 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.