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.

About the role

You will oversee the maintenance functions within formulary/medical pharmacy management and utilization management operations. This operator will have two main arms that report into them. The first arm is responsible for building and maintaining the formulary and medical pharmacy preferred drug list, and will have a team led by a Manager of Formulary Operations. The second arm is responsible for all utilization management review operations and is led by a Manager of Clinical Review Operations. The leads for each of these arms have additional direct reports who support their respective functions. You will report into the Senior Director of Clinical Pharmacy Operations and together, these two leaders will ensure maintenance operations are running effectively and and new growth opportunities are scoped and sized for future improvements and company growth.

You will report to the Senior Director, Pharmacy Clinical Operations.

Work Location:

Oscar is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture and 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, 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 is: $158,400 - $207,900 per year. You are also eligible for employee benefits, participation in Oscar’s unlimited vacation program and annual performance bonuses.

Responsibilities

Annual submission of formulary binder and medical pharmacy preferred drug list (PDL) update/ expansion
Annual review and update of pharmacy related clinical policies and formulary/UM related operational policies
Review of new trade offers from rebate aggregators in partnership with Rx Insights to identify lowest net cost preferred drug strategies
Ensure new to market drugs are reviewed weekly to determine coverage and utilization management rules
Oversight of the Pharmacy & Therapeutics Committee
Lead semi-annual updates to UM staffing model in partnership with Rx Insights and workforce management
Maintain high performance standards for recruiting, hiring, and training new team members
Partner with internal ops leads to optimize prior authorization tooling and other product enhancements to improve workflows and member/provider experience
Maintain compliance with all applicable laws and regulations
Other duties as assigned

Qualifications

Doctor of Pharmacy degree (PharmD)

Active, unrestricted US pharmacist license

5+ years of experience performing pharmacy prior authorizations or related production work
5+ years of experience supporting formulary operations (i.e. monograph development, clinical policy writing, P&T support)
3+ years in a managed care pharmacy leadership role

Bonus Points

Residency training completed from a nationally accredited program
3+ years supervising a team of prior authorization pharmacists
3+ years in management role supporting formulary operations

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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, 11 paid holidays, paid 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.

California Residents: For information about our collection, use, and disclosure of applicants’ personal information as well as applicants’ rights over their personal information, please see our Notice to Job Applicants.

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