UM Program Operations Manager executing insurance programs and leading cross-functional initiatives at Oscar Health. Ensuring regulatory compliance and operational soundness in program execution.
Responsibilities
Lead the end-to-end execution and refresh cycles for "Gold Card" and "Provider Incentive" programs.
Act as the primary owner of the "Source of Truth" for the Prior Authorization list.
Ensure all UM programs meet state and federal mandates.
Develop and maintain the Standard Operating Procedures (SOPs) for net-new initiatives.
Drive the recurring refresh cycles for auto-approval rules and provider incentive programs.
Lead the end-to-end management of cross-functional implementations/projects.
Evaluate overall departmental performance by creating, gathering, analyzing and interpreting data and metrics.
Collaboratively works with all relevant internal and external stakeholder groups.
May oversee team members directly as well as mentors team members.
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
Benefits
employee benefits
participation in Oscar's unlimited vacation program
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