Medicare Advantage Clinical Review Associate at Oscar Health
Hi, we’re Oscar. We’re a fully licensed health insurer. Our goal is to make healthcare simple, transparent, and human.
We are changing how health insurance works by creating a healthcare experience that’s intuitive and puts people, not cost or workflows, first. We’re using a consumer-focused and tech-driven approach to do so. This positions us uniquely in the space - and creates one of the biggest opportunities in healthcare.
We brought together leaders from top technology, service and healthcare companies to deliver on our promise and seize this opportunity. We all work side by side in a collaborative, energetic, and creative environment. The result: better people, better ideas, and better healthcare.
In this role, you will play an essential role in launching our Medicare Advantage business. The Clinical Review team is one of Oscar’s most important clinical functions - we encourage evidence-based practice through utilization review to ensure our members get access to the right care - particularly those who need it most. You will be responsible for understanding and helping to operationalize our regulatory requirements in our new Medicare Advantage business.
This is an exciting opportunity to be at the forefront of growth at Oscar, helping enable our innovative model reach new members.
What is the position?
Here at Oscar, we move quickly and are perpetually introducing new ideas. We need you not only to be able to think analytically and strategically, but, just as important, to execute on those ideas.
During your first six weeks, you should have:
- Developed an in depth understanding of the regulatory requirements for our Medicare Advantage business
- Developed an in-depth understanding of our clinical review Medicare Advantage workflows and data
- Begun to independently respond to escalated issues requiring analysis
- Begun to develop working relationships with key internal stakeholders (Compliance, Legal, Quality, Ops, and Tech functions)
- Begun to become a critical source of support for the rest of the Clinical Review Medicare Advantage team
Afterwards and on an ongoing basis, you will:
- Serve as project manager for the team during CMS audits
- Ensure the clinical review team is compliant to all Medicare Advantage regulations
- Support the annual CMS application process
- Help the clinical review team prepare for expansion into new markets
- Manage the development and maintenance of policies and procedures
- Work with your operational colleagues and the clinicians to deliver on continuous process improvement, from identifying pain points and needs to developing and implementing solutions
Winning factors: What leads to success
We’re looking for someone with 3-5 or more years of work experience. Must-have qualifications and expertise include:
- Acute attention to detail
- Structured/analytical thinking and problem-solving skills
- Ability to break down complex processes and communicate them and your ideas simply and clearly
- A curious mind and innate passion for making things work better
- Interest in legal regulations and how they translate to operations
- Experience in healthcare (Medicare Advantage experience preferred)
We think it will make a big (positive) difference if you have:
- A bachelor's or nursing degree
- Regulatory or compliance experience
- Experience working in a fast-moving, collaborative environment
At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we work to cultivate an environment where exceptional people can be their most authentic selves and find both belonging and support. We're on a mission to change healthcare -- an experience made whole by your unique background and perspectives.