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 help Oscar develop and review our policies given the fast pace of changes in medical literature and standards. You are responsible for our growing pharmacy policy program and driving high quality, cost-effective decision-making. You will play an essential part in our clinical organization to ensure our members receive high quality care.

You will report to the Senior Manager, Clinical Policy Development.

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: $113,600 - $149,100 per year. You are also eligible for employee benefits, participation in Oscar’s unlimited vacation program, and annual performance bonuses.

Responsibilities

Be accountable for the end-to-end process for development and review of pharmacy and medical drug guidelines and lead a team of contracted and/or matrixed reports to ensure timely review and submission of guideline updates in close partnership with our Pharmacy Operations team.
Take the lead in drafting, obtaining approval, and maintaining pharmaceutical and medical drug policies based on current clinical evidence and nationally-recognized standards
Manage direct, contracted, and matrixed team members
Responsible for ensuring processes and policies are streamlined and adhere to larger departmental strategy.
Prepare and present all materials for executive external view and feedback. Summarize changes and track evolution of pharmacy policy changes to support audit functions. Effectively communicates and presents results and recommendations across disciplines.
Responsible for high-complexity reviews that require extensive up to date industry expertise or contextual knowledge.
Partner with vendors to ensure accuracy of pharmacy code edits in claims system and prior authorization tooling and take an active role in policy customizations
Maintain high levels of subject matter expertise on pharmaceutical pipeline trends, approvals, and changes in evidentiary standards. Track evidence submissions and feedback on policies, and prioritize policy updates
Develop an in-depth understanding of regulatory and quality requirements applicable to our programs
Ensure processes and documentation are in place and in compliance with State, Federal and NCQA requirements
Provide support on regulatory audits and quality accreditation surveys, as needed
Support our clinical leaders in disseminating feedback and conducting remediation
Provide support on monitoring quality trends and identifying gaps to drive quality improvement activities
Compliance with all applicable laws and regulations
Other duties as assigned

Qualifications

PharmD degree
Active, unrestricted pharmacist license
4+ years of experience with UM reviews.
4+ years of experience with clinical research, policy development, and/or medical writing
3+ years of experience in Excel

Bonus Points

Experience working with the CVS portal and criteria, or with MCG
Experience working in a fast-paced, collaborative environment
Residency training completed from an accredited ASHP or AMCP program

Travel

10% of the time

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, 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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