Manager, Risk Adjustment, Provider Partnerships

Praxy; Northern (KY); Hybrid; USD 96,000 - 126,000; Full time

Benefits offered by this job

Unlimited vacation

Performance bonuses

Sales commissions

Job summary

Oscar Health is hiring a Manager, Risk Adjustment, Provider Partnerships to lead the RA strategy and execution across cross-functional teams including Network, Market, Data Science, and provider partners. The role owns performance management, provider engagement, and improving documentation and coding outcomes, reporting to the Director of Risk Adjustment Prospective and Planning.

It is fully remote in the U.S. with some travel.

Qualifications

• 4+ years of relevant experience in program management, strategic planning, provider partnerships, health-plan operations, risk adjustment, contracting, or a related field.
• Demonstrated experience leading complex, cross-functional programs from planning through implementation and ongoing performance management.
• Experience using quantitative and qualitative data to identify opportunities, recommend actions, and communicate conclusions to varied stakeholder audiences.
• Strong stakeholder-management, communication, and problem-solving skills, including experience navigating external partner relationships.
• Risk adjustment experience in a health plan, provider organization, health system, or consulting environment.
• Experience with provider contracting, value-based care, provider performance programs, or provider engagement models.
• SQL/BigQuery or comparable analytical-tool experience.
• Lean/Six Sigma, or similar process improvement experience.

Responsibilities

• Lead the end-to-end strategy, implementation, and ongoing management of the Risk Adjustment Provider Partnerships program, including program plans, milestones, operating rhythms, risks, and success metrics.
• Partner with Network, Market, Legal/Contracting, Risk Adjustment, and Data Science teams to incorporate risk-adjustment requirements and enablement approaches into provider agreements and operating models.
• Establish and maintain operational relationships with provider organizations; drive alignment on performance expectations, improvement opportunities, and mutual commitments.
• Analyze provider performance, workflows, and documentation/coding trends to identify causes, prioritize opportunities, and develop targeted mitigation and improvement plans.
• Lead cross-functional implementation of provider-specific interventions; manage dependencies, resolve issues, and escalate decisions or risks that threaten outcomes or timelines.
• Develop and communicate performance reporting, program insights, risks, and recommendations to internal leaders and external partners.
• Build scalable provider education, engagement, and incentive approaches that improve adoption of risk-adjustment best practices.
• Compliance with all applicable laws and regulations.
• Other duties as assigned.

Skills

Program management

Cross-functional leadership

Data analysis

Stakeholder management

Risk adjustment experience

Contracting experience

SQL/BigQuery

Lean/Six Sigma

Job description

Hi, we're Oscar. We're hiring a Manager, Risk Adjustment, Provider Partnerships to join our Strategic Planning 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 ourselves—one that behaves like a doctor in the family.

About the role:

The Manager, Risk Adjustment (RA), Provider Partnerships leads the strategy and execution of Oscar's provider-facing risk adjustment initiatives. You will own cross-functional program delivery across Risk Adjustment, Network, Market, Data Science, and external provider partners; establishes the provider engagement and performance-management approach; and translates performance data into targeted improvement strategies. You will represent Risk Adjustment priorities in contract, implementation, and operational planning discussions, manages risks and dependencies, and drives measurable improvement in documentation and coding outcomes.

You will report into the Director, Risk Adjustment Prospective and Planning.

Work Location: This position is fully remote and open to candidates residing in the U.S., excluding Alaska; Delaware; Hawaii; Louisiana; Montana; North Dakota; Oklahoma; West Virginia; Wyoming; and U.S. Territories. Daily work is completed from your home office, with occasional travel required for team meetings and company events. #LI-Remote

Pay Transparency: The base pay for this role in the states of California, Connecticut, New Jersey, New York, and Washington is: $106,812 - $140,191 per year. The base pay for this role in all other locations is: $96,131 - $126,172 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program, annual performance bonuses and sales commissions.

Responsibilities:

• Lead the end-to-end strategy, implementation, and ongoing management of the Risk Adjustment Provider Partnerships program, including program plans, milestones, operating rhythms, risks, and success metrics.
• Partner with Network, Market, Legal/Contracting, Risk Adjustment, and Data Science teams to incorporate risk-adjustment requirements and enablement approaches into provider agreements and operating models.
• Establish and maintain operational relationships with provider organizations; drive alignment on performance expectations, improvement opportunities, and mutual commitments.
• Analyze provider performance, workflows, and documentation/coding trends to identify causes, prioritize opportunities, and develop targeted mitigation and improvement plans.
• Lead cross-functional implementation of provider-specific interventions; manage dependencies, resolve issues, and escalate decisions or risks that threaten outcomes or timelines.
• Develop and communicate performance reporting, program insights, risks, and recommendations to internal leaders and external partners.
• Build scalable provider education, engagement, and incentive approaches that improve adoption of risk-adjustment best practices.
• Compliance with all applicable laws and regulations.
• Other duties as assigned.

Requirements:

• 4+ years of relevant experience in program management, strategic planning, provider partnerships, health-plan operations, risk adjustment, contracting, or a related field.
• Demonstrated experience leading complex, cross-functional programs from planning through implementation and ongoing performance management.
• Experience using quantitative and qualitative data to identify opportunities, recommend actions, and communicate conclusions to varied stakeholder audiences.
• Strong stakeholder-management, communication, and problem-solving skills, including experience navigating external partner relationships.
• Risk adjustment experience in a health plan, provider organization, health system, or consulting environment.
• Experience with provider contracting, value-based care, provider performance programs, or provider engagement models.
• SQL/BigQuery or comparable analytical-tool experience.
• Lean/Six Sigma, or similar process improvement experience.

This is an authentic Oscar Health job opportunity.

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. We're 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 applicant’s disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team ([email removed]) to make the need for an accommodation known.

California Residents: For information about our collection, use, and disclosure of applicants’ personal information as well as applicants’ rights over their personal information, please see our Privacy Policy .

Pay

base pay for this role in all other locations is: $96,131 - $126,172