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Manager, Clinical Policy

$131k-172k/hr•Full-timeRemote

location_onElm Street Historic District, Downtown Hartford, Clay Arsenal, Hartford, Capitol Planning Region, Connecticut, 06155, United States

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Job Description

About Oscar Health

Oscar is the first health insurance company built around a full-stack technology platform and a 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. Our mission is to change health care, an experience made whole by our unique backgrounds and perspectives. We cultivate an environment where people can be their most authentic selves and find both belonging and support.

About the Role

You will be a key member of our Clinical Policy team within the Office of Clinical Affairs (OCA). You will work regularly with cross-functional leaders to ensure our vended policy sets drive affordability and clinical quality goals. You will oversee the clinical assessment of policies, ensuring accuracy, and validate the vendor's development, maintenance, and implementation processes. You will report to the Senior Manager, Clinical Policy Development.

Work location

Work model: Remote

Elm Street Historic District, Downtown Hartford, Clay Arsenal, Hartford, Capitol Planning Region, Connecticut, 06155, United States

Hartford, Connecticut

Open in Google Maps(41.76386, -72.68505)

Key Responsibilities

  • check_circleClinically evaluate vendor policy sets for accuracy and standards compliance
  • check_circleStreamline and standardize vendor policy processes and documentation
  • check_circleTrack deliverables to ensure SLAs and TAT compliance
  • check_circlePrepare and present materials for executive review and feedback
  • check_circleEnsure compliance with State, Federal, and NCQA regulatory requirements
  • check_circleSupport regulatory audits and quality accreditation surveys
  • check_circleCollaborate with cross-functional partners on clinical affordability initiatives
  • check_circleVet vendor policy sets for affordability opportunities and strategic alignment
  • check_circleConduct high-complexity clinical reviews requiring industry expertise

Requirements

  • verifiedBachelor's degree in PA, NP, APRN, BSN, or RN
  • verifiedActive, unrestricted clinical license
  • verified4+ years clinical policy development or evaluation experience
  • verified4+ years utilization management and/or clinical operations experience
  • verified3+ years communicating and presenting to stakeholders
  • verified2+ years Excel/Google Sheets and PowerPoint/Google Slides
  • verifiedWorking knowledge of medical coding (CPT, ICD-10, HCPCS) and claims

Benefits & Perks

check_circleEmployee benefits eligibilitycheck_circleUnlimited vacation program

Skills, education and keywords

Skills: clinical policy development, utilization management, clinical operations, medical coding, cpt, hcpcs, excel, google sheets, powerpoint, google slides.

Education: Bachelor's degree (minimum) in a relevant field of study.

Frequently asked questions about Manager, Clinical Policy at Oscar Health

What does a Manager, Clinical Policy at Oscar Health do?expand_more
In this Manager, Clinical Policy at Oscar Health role, you will clinically evaluate vendor policy sets for accuracy and standards compliance; streamline and standardize vendor policy processes and documentation; track deliverables to ensure slas and tat compliance; and prepare and present materials for executive review and feedback.
What are the requirements for this Manager, Clinical Policy role?expand_more
To qualify for the Manager, Clinical Policy at Oscar Health position, applicants should have: Bachelor's degree in PA, NP, APRN, BSN, or RN; Active, unrestricted clinical license; 4+ years clinical policy development or evaluation experience; 4+ years utilization management and/or clinical operations experience; 3+ years communicating and presenting to stakeholders; and 2+ years Excel/Google Sheets and PowerPoint/Google Slides.
What is the salary range for Manager, Clinical Policy at Oscar Health?expand_more
The advertised salary range for Manager, Clinical Policy at Oscar Health is $131k-172k/hr.
Where is the Manager, Clinical Policy role at Oscar Health located?expand_more
Manager, Clinical Policy at Oscar Health is based in Elm Street Historic District, Downtown Hartford, Clay Arsenal, Hartford, Capitol Planning Region, Connecticut, 06155, United States. This is a remote role.
Is this Manager, Clinical Policy job remote, hybrid, or on-site?expand_more
Oscar Health has listed this Manager, Clinical Policy role as remote.
How much experience is required for this Manager, Clinical Policy role?expand_more
Manager, Clinical Policy at Oscar Health typically requires 4+ years of relevant experience at the mid level level.
What skills do you need for the Manager, Clinical Policy role at Oscar Health?expand_more
Key skills for Manager, Clinical Policy at Oscar Health include clinical policy development; utilization management; clinical operations; medical coding; cpt; hcpcs; excel; and google sheets.
What education is required for Manager, Clinical Policy at Oscar Health?expand_more
Educational requirements for this role: Bachelor's degree (minimum) in a relevant field of study.
What category does the Manager, Clinical Policy role belong to?expand_more
Manager, Clinical Policy at Oscar Health is part of the Healthcare & Nursing job category on Recrutus.