Senior Program Manager
Posted on 8/10/2022
- Bachelor's degree or 4 years of equivalent experience
- 4+ years of Healthcare experience in Quality Improvement, Risk Adjustment and Cost Management
- Knowledge of HEDIS and accrediting body requirements (i.e.; NCQA, QHP)
- Experience in project/program management and/or experience with Lean philosophies and tools
- Experience and knowledge of care management, cost of care, utilization management, and clinical/medical population health management
- Accountable for clinical and quality outcomes with assigned providers within the region you are aligned to
- Serve as an outward facing clinical professional to help create or redesign care programs focused on ensuring access to care, appropriate site of care and reduce out of network care
- This position works to provide clinical and operational management for quality and affordability initiatives and works with multidisciplinary teams to support design and implementation of key strategic programs
- Works with a particular focus on provider partnerships, cost of care and quality in order to launch innovative care models
- The position requires the ability to lead by influence in close connection with the VC, MCM, Quality and PopHealth teams
- Design, deploy and manage provider-based and regional strategies that support clinical and quality as well as use data to help providers meet utilization, clinical and quality targets
- Assist in the evaluation and identification of opportunities around utilization, quality and risk adjustment and work side by side with external partners in the design and launch of programs to improve quality and cost of care
- Serves as a quality (HEDIS, QRS, CAHPS) and clinical (Risk adjustment and utilization management) support and resource with internal and external constituents
- Other duties as assigned
- Current, active California RN/BSN, NP or PA license
- Experience with provider group practices and operations, MSO and acute hospital
- Experience working in a health plan setting preferred value-based payment and delivery models, such as HMO, ACO, PCMH, bundled payments
- Presentation mastery experience at all levels including senior management, along with preparation of reports, graphs, and spreadsheet illustrations
Health insurance company
Oscar Health’s mission is to make high-quality health insurance accessible and affordable for everyone. The company is a software driven health insurance company that offers medical plans, medicare advantages, and small group products.
- Health insurance - That’s a given. Employees and their families receive incredible health insurance.
- Financial benefits - A penny saved....we’re talking about a 401K plan, health savings accounts, and more.
- Well @ Oscar - We care about your wellness with fitness classes and access to mental health support.
- Work-Life Balance - We offer multiple time-off options, wellness days, and 10+ weeks of parental leave.
- Learning & Development - We offer everything from mentorship to management training.
- What we do is a big deal. We’re solving problems that change and save lives.
- Powered by people. Members above all. Developing and growing others is what raises the bar.
- No genius without grit. Be relentless. Be scrappy. Trying and failing beats not trying and changing nothing.
- Seek the truth... but never assume you’ve found it. Be scientific.
- Inspire & provoke. Develop and display leadership at all levels. Fight to be the best.
- Be transparent. Give and ask for direct feedback. Be grateful for and excited by the help of others.
- Make it right. Admit your mistakes. Then learn from them. Never build alone.