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Manager of Utilization Management Program Operations

Oscar HealthTempe, Arizona, United States
Hybrid Full-time $105.8K/yr - $138.9K/yr

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Experience Level

Manager

Qualifications

We are looking for a detail-oriented professional with a strong background in program operations, particularly in healthcare or insurance. You should possess excellent organizational skills, the ability to manage multiple projects simultaneously, and a keen understanding of compliance and regulatory standards in healthcare.

About the job

Join Oscar as a Manager of Utilization Management (UM) Program Operations, where you'll be a vital member of our UM Strategy team.

At Oscar, we have revolutionized health insurance by building our company around a comprehensive technology platform with an unwavering focus on our members' needs. Founded in 2012, we aim to create a health insurance experience that feels personal and attentive, much like having a caring doctor in the family.

About the Role:

The UM Program Operations Manager acts as the 'Execution Engine' for our UM Strategy team. While our strategists focus on what needs to be done, you will take ownership of how it gets executed. Your responsibilities will include the seamless management of high-impact initiatives such as Gold Carding, Provider Incentive Programs, and the upkeep of our Prior Authorization (PA) List. You will ensure that all programs are operationally robust, compliant with regulations, and scalable as we grow.

You will report directly to the Director of UM Authorization Strategy.

Work Location: This role is based in our Tempe, Arizona office, with a hybrid work model that requires in-office attendance three days a week. Thursdays are mandatory in-office days for team meetings and events, while the other two days can be flexible.

Compensation Transparency: The base salary for this position ranges from $105,808 to $138,886 annually. In addition, you will have access to employee benefits, participation in Oscar's unlimited vacation program, and annual performance bonuses.

Key Responsibilities:

  • Lead the execution and refresh cycles of the 'Gold Card' and 'Provider Incentive' programs, managing criteria for provider entry and exit, coordinating clinical audits, and ensuring accurate provider status updates.
  • Serve as the primary custodian of the 'Source of Truth' for the Prior Authorization list, leading cross-functional governance to maintain clinical adherence across all systems and public documents.
  • Ensure all UM programs comply with state and federal mandates, including new 'Gold Card' legislation and transparency requirements, acting as the point of contact for Legal and Compliance audits.
  • Develop and maintain Standard Operating Procedures (SOPs) for new initiatives, ensuring operational blueprints are in place for repeatable innovation.
  • Drive recurring refresh cycles for auto-approval rules and provider incentive programs, ensuring alignment with evolving clinical guidelines and medical policies.

About Oscar Health

Oscar is pioneering a new approach to health insurance by integrating a technology-centric model that prioritizes the needs of our members. Founded in 2012, we are dedicated to transforming the healthcare experience into one that is accessible, transparent, and personal.

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