Senior Program Manager, Clinical Quality

Job Description

Hi, we're Oscar. We’re hiring a Senior Program Manager, Clinical Quality to join our Market P&L 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:

The Senior Program Manager for Clinical Quality in collaboration with the Regional Medical Director and internal Oscar teams, will be responsible for collaborating with all externally facing partners to transform care delivery, quality and affordability. Priority is given to delivering on the Quadruple Aim (lower cost care, increased quality, increased member satisfaction and physician satisfaction). The role is expected to coordinate with internal, cross-functional matrix teams, as well as with executive leadership and clinical staff in provider organizations.

You will report into the West Region Director. This is a remote / work-from-home role. You must reside in: California. Note, this list of states is subject to change. #LI-Remote

Expected Travel Required: 30%

Responsibilities:

• Accountable for clinical and quality outcomes with assigned providers within the region you are aligned to
• Serve as an outward facing clinical professional to help create or redesign care programs focused on ensuring access to care, appropriate site of care and reduce out of network care
• This position works to provide clinical and operational management for quality and affordability initiatives and works with multidisciplinary teams to support design and implementation of key strategic programs.
• Works with a particular focus on provider partnerships, cost of care and quality in order to launch innovative care models
• The position requires the ability to lead by influence in close connection with the VC, MCM, Quality and PopHealth teams
• Design, deploy and manage provider-based and regional strategies that support clinical and quality as well as use data to help providers meet utilization, clinical and quality targets.
• Assist in the evaluation and identification of opportunities around utilization, quality and risk adjustment and work side by side with external partners in the design and launch of programs to improve quality and cost of care.
• Serves as a quality (HEDIS, QRS, CAHPS) and clinical (Risk adjustment and utilization management) support and resource with internal and external constituents
• Other duties as assigned

Requirements:

• Bachelor’s degree or 4 years of equivalent experience
• 4+ years of Healthcare experience in Quality Improvement, Risk Adjustment and Cost Management
• Knowledge of HEDIS and accrediting body requirements (i.e.; NCQA, QHP)
• Experience in project/program management and/or experience with Lean philosophies and tools
• Experience and knowledge of care management, cost of care, utilization management, and clinical/medical population health management

Bonus points:

• Current, active California RN/BSN, NP or PA license.
• Experience with provider group practices and operations, MSO and acute hospital
• Experience working in a health plan setting preferred value-based payment and delivery models, such as HMO, ACO, PCMH, bundled payments
• Presentation mastery experience at all levels including senior management, along with preparation of reports, graphs, and spreadsheet illustrations

This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here .

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.

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 .

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 ([email protected]) to make the need for an accommodation known.

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 [email protected] 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.