Analyst, Clinical Policy and Performance

Analyst, Clinical Policy and Performance

Hi, we're Oscar. We're hiring an Analyst for Clinical Policy & Performance to join our Clinical Policy & Performance Team.

Oscar is the first health insurance company built around a full stack technology platform and a relentless 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 play an essential part in our utilization management function by supporting clinical programs.

By joining the Clinical Policy and Performance Team, you will support Oscar's clinical programs which include medical and pharmacy policies, utilization management quality audits and inter-rater reliability testing, prior authorization (PA) lists, and more. In your day to day, this means managing clinical audits, document distribution, and supporting strategic projects.

You will report to the Senior Manager of Clinical Operations. This is a remote / work-from-home role. You must reside in one of the following states: Arizona, California, Connecticut, Florida, Georgia, Illinois, Maryland, Massachusetts, Michigan, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, Tennessee, Texas, Utah, Virginia, or Washington. Note, this list of states is subject to change. #LI-Remote

Responsibilities:

  • Develop an in-depth understanding of the clinical services we review for prior authorization
  • Provide document management and distribution support our growing suite of clinical policies and prior authorization list versions
  • Query clinical review cases for clinical audits of our internal clinical staff and external UR vendors
  • Support strategic programs and partnerships with external partners and vendors
  • Develop an understanding of and track regulatory and quality requirements applicable
  • Provide support on regulatory audits and quality accreditation surveys
  • Support the team for expansion into new markets

Requirements:

  • Bachelor's degree or equivalent full time work experience in a relevant area (4+ years)
  • 1+ years professional experience in business analytics or healthcare
  • 1+ years experience with SQL
  • 1+ years experience developing/modifying dashboards using Looker, Periscope, Google Data Studio, Tableau or other business intelligence software

Bonus points:

  • 1+ years experience presenting findings to all partners
  • Passion for changing healthcare

Life at Oscar: 

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.

We aim to make health care affordable and accessible for all, and apply this same vision to our perks and benefits, including: medical benefits, generous paid-time off, paid parental leave, retirement plans, company social events, stocked kitchens, wellness programs, and volunteer opportunities.

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.

Pay Transparency Policy:

Oscar ensures that you won't be discharged or discriminated against based on whether you've inquired about, discussed, or disclosed your pay. Read the full policy here.

COVID-19 vaccine requirements for in-person work:

To protect the health and safety of our employees, we require any employee conducting in-person work* to be fully vaccinated against COVID-19 by their start date. If you are unable to be vaccinated due to medical or protected religious reasons, please reach out to our Benefits team at accommodations@hioscar.com to submit an accommodations request.

*Note: In-person work includes: employees required to work from our offices, employees conducting sales work in the field and employees conducting at-home or in-person visits with members.

Logos/outerjoin logo full

Outer Join is the premier job board for remote jobs in data science, analytics, and engineering.