Hi, we're Oscar. We're hiring a Prior Authorization Pharmacy Technician to join our Pharmacy Tech 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:

You will be dedicated to high quality pharmacy decision-making and improving the member and provider experience. This position is responsible for processing prior authorizations requests and providing support for escalated issues related to prior authorizations.

You will report into the Pharmacy Technician Supervisor.

Work Location: This is a remote position, open to candidates who reside in: Alabama; Arizona; Arkansas; Colorado; Connecticut; District of Columbia; Florida; Georgia; Idaho; Illinois; Indiana; Iowa; Kansas; Kentucky; Maine; Maryland; Massachusetts; Michigan; Minnesota; Missouri; Nevada; New Hampshire; New Jersey; New Mexico; North Carolina; Ohio; Oregon; Pennsylvania; Rhode Island; South Carolina; Tennessee; Texas; Utah; Vermont; or Virginia. While your daily work will be completed from your home office, occasional travel may be 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: $19.11 - $25.08 per hour. The base pay for this role in all other locations is: $17.20 - $22.57 per hour. You are also eligible for employee benefits and monthly vacation accrual at a rate of 15 days per year.

Responsibilities:

• Use Oscar and vendor tools to determine eligibility, screen for required documents, create, process, and properly track pharmacy prior authorization requests
• Prepare, organize, and distribute pharmacy prior authorization requests for review by pharmacist/physician and respond to pharmacist/physician requests for additional information
• Collect relevant medical information (via telephone, fax, and portal) and apply the appropriate PA criteria, clearly documenting all communication and decision making
• Meet required decision-making timeframes, including promptly triggering escalation for cases requiring pharmacist review
• Communicate oral and written prior authorization outcome notifications that comply with standards and requirements for content and accuracy
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• 2+ years of work experience in a pharmacy related field in a retail or managed care plan setting and/or prior authorization experience
• Active, unrestricted Pharmacy Technician certification (CPhT)
• Excellent customer service, phone etiquette, and typing skills

Bonus Points:

• 1+ years of performing pharmacy reviews for a managed care plan or pharmacy benefits manager
• Experience working with CVS Caremark's portal and criteria
• In-depth understanding of how to operationalize step therapy rules and regulations
• Strong verbal and written communications, and interpersonal interactions

Hi, we're Oscar. We're hiring a Prior Authorization Pharmacist to join our Pharmacy 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:

This role serves as a reviewer of prior authorizations.

You will report into the Clinical Pharmacist Supervisor.

Work Location: This is a remote position, open to candidates who reside in: Alabama; Arizona; Arkansas; Colorado; Connecticut; District of Columbia; Florida; Georgia; Idaho; Illinois; Indiana; Iowa; Kansas; Kentucky; Maine; Maryland; Massachusetts; Michigan; Minnesota; Missouri; Nevada; New Hampshire; New Jersey; New Mexico; North Carolina; Ohio; Oregon; Pennsylvania; Rhode Island; South Carolina; Tennessee; Texas; Utah; Vermont; or Virginia. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events. #LI-Remote

Pay Transparency: The base pay for this role is: $ $111,780 -146,711.25 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.

Responsibilities:

• Review and render decisions on authorizations and appeals for specialty, non-specialty, and physician administered drugs
• Conduct peer-to-peer calls with prescribers to discuss the clinical rationale of adverse determinations
• Participate in clinical quality audits and inter-rater reliability testing
• Provide internal team support for escalations and questions
• Apply clinical expertise to ensure appropriate and safe use of pharmaceuticals by members and providers.
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• 3+ years of experience as a licensed pharmacist
• 2+ years of experience performing prior authorization review in a managed care setting
• Active, unrestricted pharmacist license
• Doctor of Pharmacy Degree
• Willingness to obtain licensure/training with new states

Bonus points:

• Clinical experience applying clinical criteria in clinical review setting
• Board Certification (i.e. BCPS, BCOP)
• Residency training
• Experience practicing pharmacy in a clinical setting (i.e. retail, hospital, and specialty)

Hi, we're Oscar. We're hiring a Nurse Supervisor to join our Utilization Management Clinical Quality 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:

You will provide day-to-day oversight and management of the team. You will also own daily Nurse team operations, including queue and volume throughput and staffing, and also serve as the primary escalation point for your teams. You will support strategic and clinical initiatives as needed.

You will report into the Manager, Clinical Programs

Work Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; or Texas. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events. #LI-Remote

Pay Transparency: The base pay for this role is: $91,908 - $120,629 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program, and annual performance bonuses.

Responsibilities:

• Own daily workforce management, including staffing and queue assignments, PTO/leave, and payroll/compensation.
• Manage queue on a daily basis, ensuring compliance with regulatory timelines, staff coverage, and coordination with internal teams for forecasting and timely handling of ad hoc escalations
• Ensure team adheres to department policies and workflows and serve as continual champion of the Oscar mission.
• Drive and own the success of clinical auditing and performance through ongoing evaluations; effectively use Oscar tools to monitor and trend nurse productivity and auditing data for assessment and reporting.
• Support the onboarding and training of newly-hired clinicians and partner with the Clinical Quality & Training team on the development and maintenance of clinical training and resource material.
• Partner with the Talent Acquisition team on clinical hiring initiatives.
• Complete medical necessity and level of care reviews using clinical judgment and the Plan's designated clinical guidelines, if applicable.
• Comply with department performance and quality metrics, and adhere to training and remediation requirements.
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• Active, unrestricted Registered Nurse (RN) licensure from the United States and in the state of hire, OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC)
• Associate Degree and/or Bachelors of Nursing from an accredited school of nursing
• 5+ years healthcare experience (including at least 2 years clinical practice in an acute care setting)
• 3+ years of utilization review experience at a managed care plan or provider organization
• 1+ years of direct-report leadership of a clinical team at a managed care plan or healthcare organization including in a virtual environment.
• A working knowledge of health insurance/benefit concepts - Medicare and Individual Marketplace insurance experience preferred.

Bonus points:

• Experience in healthcare quality assurance
• Strong understanding of NCQA accreditation standards for utilization management, case management or population health, HEDIS measures and other regulatory requirements
• CCM or MCG certification
• Experience analyzing and interpreting performance and other forms of data
• Proficiency using Google Suite

Hi, we're Oscar. We're hiring a Director, Managed Business Services to join our 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:

You will be the primary architect of our global outsourcing strategy and be responsible for the end-to-end health of our outsourced ecosystems. This service covers multiple contact center, business process and configuration functions and works with multiple vendors across several countries. This strategic leadership role designs, implements, and governs external operations to ensure they align with company quality and compliance standards, cost objectives, and customer experience goals.

You will report into the SVP, Insurance Operations

Work Location: This position is based in our New York City office, requiring a hybrid work schedule with 3 days of in-office work per week. Thursdays are a required in-office day for team meetings and events, while your other two office days are flexible to suit your schedule. #LI-Hybrid

Pay Transparency: The base pay for this role is: $163,944 - $215,176 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program, company equity grants, and annual performance bonuses.

Responsibilities:

• Lead the ongoing analysis and cross-functional framework to determine which business functions are optimized for outsourcing versus internal retention.
• Design and execute an operating model that supports scalability, ongoing risk mitigation, and the execution of critical business initiatives across a matrixed organization.
• Drive core business transformation by identifying emerging marketplace trends and shifting the outsourcing model from transactional tasks to transformational outcomes.
• Align service provider visions with long-term corporate goals to ensure flexibility and growth as market demands change.
• Drive the end to end selection process, in partnership with Procurement and operational leaders, including RFP leadership, vendor vetting, and onboarding of partners that align with company scale and culture.
• Partner closely with Procurement to identify and execute optimal Master Service Agreements (MSAs) and Statements of Work (SOWs) while monitoring value delivery and ROI.
• Negotiate matters of significance with senior management and external executives to ensure favorable commercial terms and operationally effective programs.
• Ensure the establishment and monitoring of rigorous Service Level Agreements (SLAs) and Key Performance Indicators (KPIs) focused on financial accuracy, productivity, and member experience.
• Perform ongoing operational governance by preparing consolidated performance reports that provide actionable insights and root-cause identification for issues.
• In partnership with finance, track ROI on outsourcing initiatives. Ensure meticulous billing analysis and the identification of opportunities for long-term cost savings.
• Set and enforce rigorous standards for all offshore and nearshore sites to ensure total adherence to HIPAA, CMS regulations, SOC2, and data privacy requirements.
• Partner with internal Audit, Security, and Compliance departments to lead the operational response to any vendor-side audits or data incidents.
• Lead the transition and change management of new work streams, including the creation of documentation, training protocols, and workflow design.
• Act as the primary bridge between internal departments and external partners to ensure seamless knowledge transfer and brand consistency.
• Create an attractive value proposition for vendor staff to minimize turnover, preserve institutional knowledge, and ensure external teams are educated on company priorities.

Requirements:

• Bachelor's Degree in Business, Operations or relevant field
• 10+ years in Insurance Operations
• 8+ years working with teams in multiple locations and within multiple disciplines
• 8+ years of coaching and developing leading cross-functional people and teams
• 6+ years of experience in LEAN, Six Sigma, or other improvement methodologies
• 6+ years of experience leading large-scale implementations or expansion implementations across multiple site locations or business units
• 5+ years of experience in procurement processes, including negotiating and contracting BPO services
• 5+ years managing 3rd-party BPO/ITO relationships for major functions in insurance operations.
• Strong legal and commercial acumen with experience in multi-million dollar contract negotiations.
• Ability to influence internal/external and onshore/offshore leadership

Bonus points:

• MBA or relevant advanced degree
• 10+ years of experience on Insurance Payer side
• Advanced experience with Procurement or Contract Management functions
• Advanced experience in healthcare
• Experience managing international teams across different time zones (APAC, LATAM, EMEA).
• Proven track record of scaling an outsourcing program from "scratch" to a global footprint.