Oscar is seeking a Senior Manager, Clinical & Disease Specific Insurance Solutions to own the development and performance of health plans designed for members with specific clinical profiles, such as diabetes or COPD. Your work will directly impact our mission to change health care by ensuring these plans improve access, remove barriers, and drive better clinical outcomes.
What You'll Do
- Own the full end-to-end lifecycle of clinical and disease-specific insurance products from ideation and strategy through launch, performance management, and optimization.
- Build and manage business cases for new and existing products, including financial modeling, membership projections, and ongoing performance tracking.
- Analyze product performance using financial and membership metrics to forecast results, identify risks and opportunities, and inform decision-making.
- Lead benefit design for disease-specific plans, including augmenting existing offerings, remediating underperforming designs, and introducing new benefit structures.
- Design and manage product portfolios aligned to defined clinical populations, such as members with chronic conditions or high utilization profiles.
- Contribute to annual planning, roadmap development, and prioritization for clinical and disease-specific products.
- Identify risks, gaps, and opportunities across benefit design, performance, affordability, and access, recommending corrective actions.
- Responsible for execution of clinical plan designs through internal approvals, filings, and supporting documentation.
- Partner with regulatory and legal teams and incorporate federal and state regulatory guidance, clinical mandates, and medical policy changes into plan designs.
- Ensure compliance with all applicable laws, regulations, and internal governance standards.
- Serve as the primary product directly responsible individual (DRI) for clinical plans, coordinating all necessary plan aspects across Clinical, Actuarial, Network, Medical Affairs, Finance, Legal and Compliance.
- Develop and maintain regular performance reporting and product look-backs, assessing financial, clinical, operational, and outcomes across disease-specific populations.
- Lead cross-functional execution for clinical product enhancements, pilots, and issue resolution.
What We're Looking For
- 6+ years of experience developing, managing, or supporting commercial insurance products, including clinical programs and disease-specific product offerings.
- 5+ years of experience and understanding of clinical policy, utilization management, quality programs and regulatory requirements (ACA, state mandates, CMS guidance, etc.).
- 3+ years multi-year experience with ACA, including individual market place and small group products.
- 3+ years demonstrated ownership of end-to-end product lifecycle management.
- 3+ years experience and proven ability to lead cross-functionally in highly regulated, matrixed and sometimes vague environments.
- 3+ years experience making strong analytical and data-driven decisions with ability to translate population-specific insights into product and benefit design decisions.
- Willingness to travel up to 25% of the time.
Nice to Have
- Bachelor’s degree in business, healthcare, public policy, analytics, or related field.
- Experience developing or managing clinically differentiated health plans.
- Familiarity with medical policy development, clinical governance and provider models.
- Experience supporting regulatory filings and audits.
- Experience developing or managing products for chronic conditions, high-utilizer populations, or disease-specific cohorts.
- Experience with business intelligence tools, such as SQL or Excel.
- Experience incorporating clinical outcomes, quality measures, and care management programs into product design.
- Background in population health, value-based care, or care delivery innovation.
Technical Stack
- SQL
- Excel
Team & Environment
This role reports into the Vice President, Insurance Product Innovation and Development.
Benefits & Compensation
- 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
- Compensation range: $149,040 - $195,615 per year in New Jersey, New York, and California; $134,136 - $176,053 per year for all other locations
Work Mode
This is a remote position open to candidates in Arizona, California, Colorado, Florida, Georgia, Illinois, Massachusetts, Michigan, Nevada, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Texas, and Virginia.
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.
