Oscar Health is hiring a Manager, Policy Optimization to join the Clinical Policy team within our Office of Clinical Affairs. In this key role, you will work cross-functionally to ensure our policy process directly supports affordability goals. You will identify savings opportunities, analyze complex data, track trends, and implement process changes to improve efficiency and clinical outcomes.
What You'll Do
- Track policy performance and identify areas for process changes or optimization to drive both affordability and efficiency goals.
- Develop internal tracking systems and monitoring processes to organize projects across timelines and deliverables.
- Ensure policy opportunities are appropriately tracked and managed through our policy opportunity pipeline.
- Assess policy structures to identify functionally unnecessary components, enabling streamlined policy design and implementation.
- Create evidence-based recommendations for policy modifications, including appropriate loosening, tightening, or re-routing for additional review.
- Incorporate data to drive further iteration and improvement.
- Bring industry best practices to the policy optimization process to develop organizational frameworks, templates, process organization, and clear points of interconnectivity between policy organization and other teams.
- Maintain current knowledge of industry best practices and drive innovation and new approaches.
- Perform in-depth review of integrated claims and operational data (medical, pharmacy, lab, auths) to identify cost and trend drivers informing the clinical policy development pipeline.
- Build processes that scale across therapeutic areas.
- Create executive-ready visualizations tailored to different stakeholder audiences (clinical vs. financial).
- Maintain strong relationships, rapport, and lines of communication with stakeholders.
- Comply with all applicable laws and regulations.
What We're Looking For
- Bachelor's degree (minimum) in a relevant field of study, specifically B.S.Pharm, PharmD, PA, NP, APRN, BSN, or RN.
- Active, unrestricted clinical license.
- 4+ years of direct work with clinical policy, with particular emphasis on health insurance policy experience.
- 4+ years of work experience in utilization management and/or clinical operations.
- 3+ years of experience in designing, implementing and continuously improving programs and processes.
- 3+ years of experience communicating and presenting to stakeholders of all levels.
- 2+ years of experience using Excel/Google Sheets and PowerPoint/Google Slides.
- Working knowledge of medical coding (e.g., CPT, ICD-10, HCPCS) and/or pharmacy coding (e.g., GPI, GSN/GCN, NDC) and claims.
Nice to Have
- MBA or advanced management degree.
- Experience with commercial or ACA insurance.
- Prior work experience analyzing and modeling clinical policy outcomes.
- Prior work experience in health insurance and matrixed organizations supporting multiple stakeholders.
- Experience translating between clinical and business vocabularies.
- Project management certification.
- Consulting experience.
Technical Stack
- Excel/Google Sheets
- PowerPoint/Google Slides
Team & Environment
You will be a member of the Clinical Policy team within the Office of Clinical Affairs (OCA), reporting to the Senior Manager, Clinical Policy Development.
Benefits & Compensation
- Salary: $131,200 - $172,200 per year.
- Medical, dental, and vision benefits.
- 11 paid holidays.
- Paid sick time.
- Paid parental leave.
- 401(k) plan participation.
- Life and disability insurance.
- Paid wellness time and reimbursements.
- Unlimited vacation program.
- Annual performance bonuses.
Work Mode
This is a remote position open to candidates in the Greater Boston area.
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.
