UM Program Operations Manager

Hi were Oscar. Were 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 ourselvesone 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 position is based in our Tempe Arizona office requiring a hybrid work schedule with 3 days of in-office work per week. Thursdays are a required in-office day for team meetings and events while your other two office days are flexible to suit your schedule. #LI-Hybrid

Pay Transparency : The base pay for this role is : $105808 - $138886 per year. You are also eligible for employee benefits participation in Oscars 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 teams 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 :

Bonus points :

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. Were 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 applicants disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team () to make the need for an accommodation known.

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Required Experience :

Manager

Key Skills

Project Management Methodology,Project / Program Management,Program Management,Management Experience,Microsoft Powerpoint,Project Management,Microsoft Project,Budgeting,DoD Experience,Leadership Experience,Supervising Experience,Contracts

Employment Type : Full-Time

Experience : years

Vacancy : 1

Yearly Salary Salary : 105808 - 138886