Remote Manager, Clinical Policy | Policy & Compliance Lead

Oscar Health; Hartford (CT); Remote; USD 131,200 - 172,200; Full time

Benefits offered by this job

Unlimited vacation program

Annual performance bonuses

Employee benefits

Job summary

A leading health insurance company is seeking a Manager, Clinical Policy to join their Clinical Policy team. This fully remote role requires a Bachelor's degree and substantial experience in clinical policy development. Responsibilities include evaluating vendor policy sets for compliance, collaborating with stakeholders, and ensuring streamlined processes. The position offers competitive pay and benefits, with opportunities for professional growth.

Qualifications

• Bachelor's degree (minimum) in a relevant field.
• Active, unrestricted clinical license.
• 4+ years of experience with clinical policy development.
• 4+ years in utilization management and/or clinical operations.
• 3+ years experience communicating to stakeholders.
• 2+ years using Excel and PowerPoint.
• Working knowledge of medical coding.

Responsibilities

• Evaluate vendor policy sets for compliance and quality.
• Vet vendor policy sets for affordability opportunities.
• Streamline vendor policy and processes.
• Collaborate on clinical impact for affordability initiatives.
• Improve efficiency including in-housing analyses.
• Track deliverables for compliance with SLAs.
• Present materials for executive review and feedback.
• Conduct high-complexity industry reviews.
• Understand regulatory and quality requirements.
• Support regulatory audits and accreditation surveys.
• Ensure compliance with relevant laws.

Skills

Clinical policy development

Utilization management

Stakeholder communication

Excel/Google Sheets

PowerPoint/Google Slides

Medical coding knowledge

Education

Bachelor's degree in a relevant field (e.g., PA, NP, APRN, BSN, RN)

Job description

A leading health insurance company is seeking a Manager, Clinical Policy to join their Clinical Policy team. This fully remote role requires a Bachelor's degree and substantial experience in clinical policy development. Responsibilities include evaluating vendor policy sets for compliance, collaborating with stakeholders, and ensuring streamlined processes. The position offers competitive pay and benefits, with opportunities for professional growth.