UM Program Operations Manager

Oscar Health

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Job Description

AI Summary

• Manages end-to-end execution of high-impact utilization management programs including Gold Carding, Provider Incentive Programs, and Prior Authorization lists for Oscar Health's UM Strategy team • Ensures regulatory compliance with state and federal mandates, serves as primary contact for Legal and Compliance audits, and maintains operational soundness as the company expands • Develops and maintains Standard Operating Procedures (SOPs) for new initiatives and drives recurring refresh cycles to keep clinical guidelines and medical policies current • Leads cross-functional project implementations including planning, stakeholder engagement, and on-time delivery while managing relationships across departments • Remote position based in 17 eligible states with salary range of $105,808-$138,886, unlimited vacation, performance bonuses, and occasional travel for team meetings

Hi, we're Oscar. We're hiring a UM Program Operations Manager to join our UM Strategy 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 Manager of UM Program Operations is the "Execution Engine" of the UM Strategy team. While our strategists identify what we should do, you own the how. You are responsible for the flawless execution of high-impact programs like Gold Carding, Provider Incentive Programs, and the maintenance of our Prior Authorization (PA) List. You will ensure that every program is operationally sound, regulatory compliant, and scales effectively as our footprint expands.

You will report into the Director, UM Authorization Strategy.

Work Location:This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois; Iowa; Kansas; Michigan; Missouri; Nebraska; New Jersey; North Carolina; Ohio; Oklahoma; Pennsylvania; South Carolina; Tennessee; Texas; or Virginia. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events.#LI-Remote

Pay Transparency: The base pay for this role is: $105,808 - $138,886 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program, and annual performance bonuses.

Responsibilities:

Lead the end-to-end execution and refresh cycles for "Gold Card" and "Provider Incentive" programs. This includes managing provider entry/exit criteria, coordinating the clinical audit framework, and ensuring accurate provider status updates.
Act as the primary owner of the "Source of Truth" for the Prior Authorization list. You will lead the cross-functional governance process to ensure code additions, removals, and modifications are clinically adherent and accurately reflected across all internal systems and public-facing documents.
Ensure all UM programs meet state and federal mandates, including emerging "Gold Card" legislation and transparency requirements. You will be the team's point of contact for Legal and Compliance audits.
Develop and maintain the Standard Operating Procedures (SOPs) for net-new initiatives. You ensure that as the team innovates, the operational "blueprints" exist to make those innovations repeatable.
Drive the recurring refresh cycles for auto-approval rules and provider incentive programs, ensuring they remain current with shifting clinical guidelines and medical policies.
Lead the end-to-end management of cross-functional implementations/projects, including project plan creation, stakeholder engagement, managing cross-functional relationships to drive collaboration, edge case mitigation, and on-time completion.
Evaluate overall departmental performance by creating, gathering, analyzing and interpreting data and metrics as well as assisting in development of departmental metrics and implementation of mitigation strategies.
Collaboratively works with all relevant internal and external stakeholder groups to formulate proactive implementation, communications, and program strategies for successful change management and risk mitigation initiatives
May oversee team members directly as well as mentors team members and promotes colleagues' growth and professional development
Compliance with all applicable laws and regulations
Other duties as assigned

Requirements:

4+ years of experience in program management
3+ years of experience in delivering projects / programs
2+ years of experience in managing prior authorization list process (updates, coordination)
Experience in payer/health insurance

Bonus points:

Experience using data and metrics to drive improvements in programs
Experience / background in a fast-paced operations environment
Experience managing Gold Card programs and updates
Experience managing the Prior Authorization List process
Successfully executed enterprise-wide initiatives: defined project plans, coordinated resources, managed implementation activities, and developed all processes associated with program rollout and ongoing support
Master's Degree
PMP Certifications or Program Management Certifications
Lean/Six Sigma Certifications
Healthcare experience (Health Insurance, Health Systems, or Healthcare Consulting)

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

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.

Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.

Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.

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.

California Residents: For information about our collection, use, and disclosure of applicants’ personal information as well as applicants’ rights over their personal information, please see our Privacy Policy.

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Job Information

Company:
Oscar Health
Location:
Remote
Job Type:
Internship
Work Location:
Remote
Experience Level:
Mid
Source:
Greenhouse
Status:
Active

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76 /100

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