Senior. Manager, UM Authorization Strategy Job at Oscar Health
Hi, we're Oscar. We're hiring a Senior Manager of Utilization Management Authorization Strategy to join our Clinical Business Operations Team.
Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.
About the role:
As a Sr. Manager within our Clinical Business Operations, you will work with our clinical and non clinical teams to further improve the success of Oscar's UM Operations. You will work with our Utilization Management teams to define our Prior Authorization strategy to improve the program Return on investment. You will manage the source of truth and monitor the performance of our auth strategy. At Oscar, we never build alone. You will partner with Data Science, Clinical Analytics, Clinical UM teams, Non-clinical UM Processors, and Product.
You have remarkable experience in Utilization Management or healthcare consulting leading projects with direct impact on improving Return on investment. Additionally, you must be a systematic thinker. Experience in implementation and driving improvements in operational processes will be important.
You will report to the Sr. Director, Clinical Strategy & Optimization. This is a remote / work-from-home role. You must reside in one of the following states: Arizona, California, Connecticut, Florida, Georgia, Illinois, Maryland, Massachusetts, Michigan, New Jersey, New Mexico, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, Tennessee, Texas, Utah, Virginia, or Washington. Note, this list of states is subject to change.
The base pay for this role in the states of California, Connecticut, New Jersey, New York, and Washington is: $132,000 - $173,250 per year. The base pay for this role in all other locations is: $118,800 - $155,925 per year. You are also eligible for employee benefits, and annual performance bonuses.
Responsibilities:
- Improve the UM program's Return on investment by defining and implementing the prior authorization strategy
- Be the primary owner for managing and updating the PA list, and the rules for electronic prior authorization and gold carding to improve costs
- Evaluate data to improve and create dashboards for Senior Leadership report outs
- Partner with Data Science and clinical teams to understand current use trends and identify opportunities to bend the cost curve
- Work with the clinical policy team to make sure there is agreement between clinical policy and prior authorization strategy
- Comfortable managing a team
Requirements:
- 6+ years experience in either utilization management function or healthcare strategy and operations role with experience driving Return on investment improvements
- Bachelor's degree
- Expertise in working with data and making data backed decisions
Bonus points:
- Master's degree
- Experience in prior authorization strategy vertical with a Payer
- Clinical experience
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 and find both belonging and support. We're on a mission to change health care - an experience made whole by our unique backgrounds and perspectives..
Pay Transparency:
Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience.
Full-time employees are eligible for benefits including: medical, dental, and vision benefits, paid holidays, paid vacation and sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.
Reasonable Accommodation:
Oscar applicants are considered solely based on their qualifications, without regard to applicant's 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.
To protect the health and safety of our employees, we require any employee conducting in-person work* to be fully vaccinated against COVID-19 by their start date. If you are unable to be vaccinated due to medical or protected religious reasons, please reach out to our Benefits team at accommodations@hioscar.com to submit an accommodations request.
- Note: In-person work includes: employees required to work from our offices, employees conducting sales work in the field and employees conducting at-home or in-person visits with members.
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