Director, Case Management Operations at Oscar Health In Other

Director, Case Management Operations
Oscar Health // health insurance

Hi, we're Oscar. We're hiring a Director of Case Management Operations to join our Clinical Care team.

Oscar is the first health insurance company built around a full stack technology platform & a 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 drive & oversee the Case Management team's business strategy, program design, & outcomes. You will be accountable to program success, & the financial performance of the department, both from an administrative efficiency & affordability standpoint. You will direct & influence teams involved in building net-new programs, & optimizing existing Case Management programs to deliver medical cost savings to Oscar, & healthier outcomes to its members.

You will report to the Senior Director, Virtual Care

Work Location:

Oscar is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture & our mission.

If you live within commutable distance to our New York City office (in Hudson Square), our Tempe office (off the 101 at University Dr), or our Los Angeles office (in Marina Del Rey), you will be expected to come into the office at least two days each week. Otherwise, this is a remote / work-from-home role.

You must reside in one of the following states: Alabama, Arizona, Arkansas, California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, Virginia, Washington, or Washington, D.C. Note, this list of states is subject to change. #LI-Remote

Pay Transparency:

The base pay for this role in the states of California, Connecticut, New Jersey, New York, & Washington is: $174,400 - $228,900 per year. The base pay for this role in all other locations is: $156,960 - $206,010 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program, company equity grants, & annual performance bonuses.

Responsibilities

Define & execute the Case Management strategy to drive affordability outcomes
Lead program design, pilots, & measurement for initiatives like TOC, polypharmacy, & pre-ESRD
Manage a team of program managers with clear accountability for ROI & operational performance
Build scalable playbooks & processes for trend management & program expansion
Conduct prioritization, cost-benefit analysis, & business case development
Partner with analytics, actuarial, & finance teams to track MLR & PMPM impact
Oversee departmental budgeting & performance evaluation
Act as a thought leader & stay informed on market trends
Collaborate across teams to operationalize initiatives & drive results
Lead strategic initiatives & prepare executive-level communications
Compliance with all applicable laws & regulations
Other duties as assigned

Qualifications

Clinical background (PharmD, BSPharm, RN, LCSW, or similar) with strong clinical fluency
10+ years in healthcare strategy/operations; 6+ years in people management with outcome ownership
5+ years designing & scaling care delivery programsespecially Case Management, ideally in a payor setting
3+ years in Case Management or Population Health focused on affordability & MLR impact
Experience leading large, cross-functional initiatives across clinical, analytics, & actuarial teams
Strong analytical & financial acumen; proficient in Excel/Google Sheets & ROI modeling
Executive-level communication & influence skills
Structured, consultative approach; comfortable with ambiguity & tradeoff evaluation

Bonus Points

MPH or MBA
Experience in management consulting, particularly in healthcare strategy
Experience working in a growth-stage healthcare or health tech company
Background in delivering programs for ACA populations, including challenges related to engagement, comorbidities, & cost drivers
Familiarity with risk adjustment, medical loss ratio (MLR) levers, & per-member/per-month (PMPM) affordability tracking

This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here.

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.

Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, & experience. Full-time employees are eligible for benefits including: medical, dental, & vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life & disability insurance, & paid wellness time & reimbursements.

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.

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