Oscar

Bilingual

• Perform preventative care screenings, complete medication reconciliation, diagnose medical conditions and provide health coaching, referrals and treatment when clinically appropriate.
• Outreach members who are more chronically ill based on historical and suspected health information.
• Engage members who have a lower probability of seeing their PCP.
• Identify areas in the member's medical journey that can be improved by increasing their access to care with a licensed provider.
• Cross-train into urgent care and/or virtual primary care service line
• Interact with members virtually, including virtual assessment, diagnosis and treatment.
• Compliance with all applicable laws and regulations
• Other duties as assigned

Nurse Practitioner – Virtual Health Assessment, Bilingual Spanish

Manager

• Help inform and drive Implementation of contracting strategies in partnership with Market Leaders that align with the company's overall network adequacy, development and cost management objectives.
• Leads contract settlement negotiations, striving to reach mutually beneficial agreements with providers that maintain and enhance the provider network.
• Manage and negotiate complex contracts, including Value Based Care agreements, with healthcare providers, focusing on favorable terms and compliance with organizational standards and regulatory requirements.
• Oversee a team of contracting managers, associates and specialists facilitating leadership, guidance, and mentorship by setting strategic objectives, monitoring team performance, providing training and development opportunities, and fostering a collaborative and innovative work environment.
• Conducts comprehensive reviews and analyses of provider contracts, identifying and surfacing areas for improvement and optimization to appropriate stakeholders
• Utilizes working knowledge of provider financial issues and competitor strategies to inform negotiation and contracting decisions.
• Drive Implementation across the contracting team of contracting policies and workflows; ensure effective and efficient contracting processes are in place.
• Monitor and analyze key metrics for network performance, cost, and provider satisfaction, and provide reports to leadership.
• Ensure you and your team provide timely resolution of provider issues related to contract terms, reimbursement, and network participation.
• Build and maintain positive relationships with healthcare providers to ensure network stability and quality.
• Compliance with all applicable laws and regulations
• Other duties as assigned

Senior Manager, Network Contracting

Senior Manager, Network Contracting & Services

Recruitment

• Support the overall accessibility, availability and quality of Oscar's Provider Network
• Work in concert with various internal partners and existing and future external provider partners
• Support the provider recruitment, engagement and education function within the Network Management pillar of Oscar's Insurance Operation function
• Report into the Senior Manager, Network Development
• Travel for client meetings up to 75% of the time

Associate, Network Recruiting

Analyst

• Contribute as a subject matter expert for Oscar reimbursement policies, payment integrity internal claims processing edits and external vendor edits.
• Respond to internal and external inquiries and disputes regarding policies and edits.
• Research industry standard coding rules, summarize and provide input into reimbursement policy language and scope.
• Use knowledge gained through research and claims review to ideate payment integrity opportunities. Translate into business requirements; submit to and collaborate with internal partners to effectuate change.
• Ingest information from internal and external partners regarding adverse claim outcomes; collaborate with partners to scope, size, prioritize items and deliver solutions.
• Use insights from partner submissions, data mining, process monitoring, etc., work with the team to proactively identify thematic areas of opportunity to solve problems.
• Perpetuate a culture of transparency and collaboration by keeping stakeholders well informed of progress, status changes, blockers, completion, etc.; field questions as appropriate.
• Support Oscar run state objectives by providing speedy research, root cause analysis, training, etc. whenever issues are escalated and assigned by leadership.
• Compliance with all applicable laws and regulations
• Other duties as assigned

Senior Analyst, Payment Integrity

• Support Coordination of Benefits efforts for Payment Integrity
• Investigate and verify proper payment of Oscar medical and pharmacy claims
• Report to the Senior Manager, Payment Integrity
• Analyze, investigate and confirm if dual coverage exists for Oscar membership
• Support leadership to scope, size, prioritize items and deliver Coordination of Benefits solutions
• Utilize data analysis skills and tools to develop accurate, quantitative analyses of payment issues
• Complete quality reviews of coordination of benefits vendor findings
• Ensure compliance with all applicable laws and regulations
• Other duties as assigned

Payment Integrity Analyst

Product Manager

• Senior Staff Product Manager responsible for defining and driving complex, technical product initiatives with strategic impact across Oscar Health
• Partners with engineering, data, and design to lead cross-domain initiatives and align with senior leaders on priorities and outcomes
• Act as a force multiplier within the product organization—mentoring peers, influencing product practices, and raising the bar on quality, clarity, and impact
• Reports to the Sr. Director, Product Management
• Oscar is a blended work culture with in-office options in New York City, Tempe, and Los Angeles; remote/work-from-home role otherwise
• Reside in one of the following states: Alabama, Arizona, Arkansas, California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, Virginia, Washington, or Washington, D.C.
• Base pay for this role is $174,400 - $228,900 per year; eligible for benefits, unlimited vacation, equity grants and annual bonuses