Manager, Medical Policy

1 month ago
Full-time
Mid Level
Operations
Oscar

Oscar

Oscar is a health insurance company that offers plans for individuals, families, and small businesses. With a focus on humanizing health care through technology, design, and data, Oscar provides easy-to-understand bills, 24/7 access to doctors, and a p...

Insurance
1K-5K
Founded 2012

Description

  • Lead review of clinical literature, regulatory guidance (e.g., FDA, CMS), and specialty society guidelines to develop evidence-based coverage criteria for medical services, devices, and technologies.
  • Conduct and manage health technology assessments for novel medical technologies and complex devices.
  • Coordinate clinical review and validation of medical policies with internal and external specialty-matching physicians.
  • Translate complex clinical data and evidence-based recommendations into precise, defensible medical necessity criteria and clinical guidance.
  • Own end-to-end drafting, maintenance, and operational interpretation of the medical policy library to ensure clinically accurate and unambiguous language.
  • Prepare and present evidence-based medical policies and summaries of changes to the Clinical Advisory Subcommittee (CAS) and internal forums.
  • Oversee hiring, onboarding, development, and management of a team of clinical FTEs, contractors, and matrixed reports.
  • Ensure clinical policy development processes are streamlined and aligned with departmental and Office of Clinical Affairs strategy.
  • Ensure clinical policy development and documentation comply with State, Federal, and NCQA requirements.
  • Support regulatory audits and quality accreditation surveys and ensure compliance with applicable laws and regulations.

Requirements

  • Graduate degree in Healthcare Administration, Public Health, Health Policy, Health Services Research, Epidemiology, Nursing, or a closely related discipline.
  • 4+ years in healthcare experience, including 3+ years specifically focused on medical policy development, clinical research, or medical writing.
  • Experience in people leadership with the ability to manage, mentor, and develop clinical professionals.
  • Proficiency using clinical databases (e.g., PubMed) to conduct literature reviews, evaluate evidence, and synthesize findings into defensible recommendations.
  • Demonstrated ability to interpret complex clinical data and conduct health technology assessments to determine medical coverage standards.
  • Remote-role requirement: candidates must reside in Atlanta, GA (position is fully remote with potential future hybrid hub presence).
  • Active, unrestricted clinical license (e.g., RN, NP, PA) is a plus.
  • Working knowledge of medical coding (CPT, ICD-10, HCPCS) and claims is a plus.
  • 2+ years of experience using Excel/Google Sheets and PowerPoint/Google Slides is a plus.
  • Experience with Managed Care regulatory requirements, NCQA standards, ACA marketplace rules, utilization management, or evidence-based guideline development is a plus.

Benefits

  • Base pay range $131,200–$172,200 per year.
  • Medical, dental, and vision insurance.
  • Unlimited vacation program and paid wellness time with reimbursements.
  • Annual performance bonuses.
  • 11 paid holidays, paid sick time, and paid parental leave.
  • 401(k) plan participation, life insurance, and disability insurance.
  • Fully remote role (Atlanta, GA candidates) with potential future hybrid hub model.
  • Support for reasonable accommodations and an inclusive Equal Opportunity employment environment.

Interested in this position?

Apply directly on the company website

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