Hi, we're Oscar. We're hiring a VP, Clinical Strategy & Integration.

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 VP of Clinical Strategy & Integration serves as the operational architect and connective tissue of the Clinical organization, responsible for driving product/services development and execution across the organization—including Virtual Care, Case Management, Pharmacy,  Utilization Management, Provider Network and Member Experience—into a high-performing, unified clinical orchestration ecosystem.  By balancing strategic vision with rigorous operational execution, this leader builds the scalable infrastructure, data interoperability, and cross-functional workflows necessary to transform clinical insights into a cohesive, end-to-end care model.

This leader drives enterprise value and clinical excellence by aligning product development, strategy, operations, technology, and policy. They will act as the operational backbone of the Clinical organization — ensuring clinical and operational leaders are enabled with the right tools, insights, and support to perform at their best. Through the standardization of evidence-based care practices and the data-driven continuous optimization of clinical programming and systems, the VP ensures that cross-functional teams are aligned and empowered to manage medical trends effectively, improve member outcomes, and deliver a more affordable, seamless healthcare experience.

You will report into the Chief Health Officer.

Work Location: This position is based in our New York 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: $264,132 - $346,673 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program, company equity grants and annual performance bonuses.

Responsibilities:

• “Consumer First” Clinical strategy development: Develop and execute strategic plans to transform traditional UM to care orchestration between health plan coverage, provider networks and members.  Directly drive execution for scalability, workflow efficiency and member experience leveraging tech and automated solutions.
• Health Solutions Product Pipeline: drive the development of new health solutions products in partnership with plan design, affordability and growth; leverage direct member marketing and engagement.
• Strategic alignment: Align Clinical Operations functions with overall strategic goals, particularly in areas of trend management, quality improvement and member satisfaction; drive collaboration across departments to ensure integrated service delivery.
• Strategic initiatives and transformation: Orchestrate the execution of high-priority, cross-functional initiatives that bridge the gap between clinical strategy and execution. Apply rigorous program management discipline to ensure that complex Clinical projects are delivered on time, aligned with enterprise KPIs, and supported by the necessary change management to drive long-term organizational adoption.
• Performance analytics: Analyze operational data to identify trends, risks and opportunities for improvement; spearhead the development of a framework that translates real-time performance data into actionable insights; leverage these analytics to refine clinical policies, optimize care pathways, and empower providers with the point-of-care tools necessary to drive superior health outcomes and medical trend management.
• Clinical intelligence: Monitor external market trends, emerging care technologies, regulatory shifts and population health trends to inform multi-year business planning; translate these external signals—along with internal performance data—into actionable strategies that evolve our clinical operating model, ensuring the organization remains a leader in care delivery.
• Technology partnership: Partner with Technology organization and Clinical leadership to identify and deliver new systems, tools and capabilities, prioritize technology initiatives across the Clinical organization, and oversee implementation of solutions to achieve business objectives.
• Management process and governance: Lead clinical governance model to promote alignment and collaboration; establish the right key performance indicators, regularly monitor and report on progress to executive leadership team (including Clinical Quarterly Business reviews).
• People management: Manage and mentor a team while fostering a culture of collaboration, innovation and accountability.
• Financial planning and performance: Monitor financial performance and implement cost saving measures without compromising quality or member experience.
• Compliance with all applicable laws and regulations 
• Other duties as assigned 

Requirements:

• 15+ years of experience in healthcare industry
• 7+  years Managed Care experience in an operations environment
• 5+  years experience in managing a large/cross functional end-to-end product teams
• 5+  years managing budget and capacity models

Bonus points:

• Experience leading programs tied to clinical outcomes in value based models
• Formal business process/management engineering training

Hi, we're Oscar. We're hiring a Physician Reviewer to join our Utilization Management 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 determine the medical appropriateness of inpatient, outpatient, and pharmacy services by reviewing clinical information and applying evidence-based guidelines.

Hours: 8am - 5pm in your local time zone

Call rotation - 1 weekend every 16 weeks

You will report into the Associate Medical Director, Utilization Management.

Work Location: This is a remote position, open to candidates who reside in the United States. 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: $211,200 - $ 277,200 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation, and annual performance bonuses.

Responsibilities:

• Provide timely medical reviews that meet Oscar's stringent quality parameters.
• Provide clinical determinations based on evidence-based criteria and Oscar internal guidelines and policies, while utilizing clinical acumen.
• Clearly and accurately document all communication and decision-making in Oscar workflow tools, ensuring a member could easily reference and understand your decision (Flesch-Kincaid grade level).
• Use correct templates for documenting decisions during case review.
• Meet the appropriate turn-around times for clinical reviews.
• Receive and review escalated reviews.
• Conduct timely peer-to-peer discussions with treating providers to clarify clinical information and to explain review outcome decisions, including feedback on alternate treatment based on medical necessity criteria and evidence-based research.
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• Board certification as an MD or DO
• Licensed in one of these states: FL, NC, AZ OR possess an active Interstate Medical Licensure Compact (IMLC).
• 6+ years of clinical practice

Bonus points:

• Licensure in multiple Oscar states
• 1+ years of utilization review experience in a managed care plan (health care industry)
• BC in Cardiology, Radiation/Oncology, or Neurology
• Experience with care management within the health insurance industry.
• Willing and able to obtain additional state licensure as needed, with Oscar's support

Hi, we're Oscar. We're hiring a to join our Clinical Data Analytics 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 partner closely across the organization to identify and manage inefficiencies proactively in the business. You will support business units in scoping, analyzing and monitoring performance of key financial and utilization metrics in service of company goals. You will independently drives the scoping & execution of analytical requests, including working with stakeholders to define key questions, scope methodologies and results. You will be called upon to speak to prepared analysis both internally and externally.

You will report into the Senior Manager, Clinical Analytics.

Work Location: This position is based in our Tempe, Arizona 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: $91,659 - $120,303 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program, and annual performance bonuses.

Responsibilities:

• Responsible for owning insights generation and follow-up for a major business unit, serving as the first point of contract for Sr. Managers and Associate Directors
• Analyze data to support business teams in making better informed, data-driven decisions
• Use data to tell a story that non-technical colleagues will be able to understand, including packaging and presenting findings in a clear, concise and compelling manner
• Recognize the need to enhance essential operational and analytical dashboards, and define the requirements to enhance them as our user's needs evolve
• Identify opportunities to create models and tools that produce relevant insights to identify healthcare inefficiencies and generate insights to remove inefficiencies
• Collaborate across the organization, including owning stakeholder relationships with managers & senior managers , to identify actions to achieve improvements and monitor initiative impact
• Support other strategic projects as assigned to meet business needs
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• 3+ years of technical work experience using analytical tools and writing analytical reports
• 3+ years demonstrated ability to work with large datasets and distill analyses into relevant insights with a structured and systematic thought process
• Strong communication skills, verbal and written, around business reporting impact and requirements, as demonstrated by 5+ examples / projects of presenting analysis to Leadership (Director+)
• 3+ years experience in SQL, with the ability to filter, aggregate, and build CTEs, or proficiency in R or Python, including experience with Pandas, for loops, and statistical tests
• 3+ years experience developing dashboards and working with Looker, or other business intelligence/data visualization tools
• 3+ years experience, including proficiency in Google Sheets or Excel skills, with ability to use VLookup, nested if statements and connected Sheets
• 1+ years experience in healthcare, consulting, finance or the insurance industry

Bonus points:

• 2+ years experience in preparing healthcare analytics and reporting
• 2+ years experience managing value-based contracts at a payer or a provider organization (ACO, CIN, MSO etc.)
• Exposure to healthcare contract negotiations, risk adjustment, ACA marketplace, quality of care, and/or population health experience

Hi, we're Oscar. We're hiring a to join our Clinical Data Analytics 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 partner closely across the organization to identify and manage inefficiencies proactively in the business. You will support business units in scoping, analyzing and monitoring performance of key financial and utilization metrics in service of company goals. You will independently drives the scoping & execution of analytical requests, including working with stakeholders to define key questions, scope methodologies and results. You will be called upon to speak to prepared analysis both internally and externally.

You will report into the Senior Manager, Clinical Analytics.

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: $101,844 - $133,670 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program, and annual performance bonuses.

Responsibilities:

• Responsible for owning insights generation and follow-up for a major business unit, serving as the first point of contract for Sr. Managers and Associate Directors
• Analyze data to support business teams in making better informed, data-driven decisions
• Use data to tell a story that non-technical colleagues will be able to understand, including packaging and presenting findings in a clear, concise and compelling manner
• Recognize the need to enhance essential operational and analytical dashboards, and define the requirements to enhance them as our user's needs evolve
• Identify opportunities to create models and tools that produce relevant insights to identify healthcare inefficiencies and generate insights to remove inefficiencies
• Collaborate across the organization, including owning stakeholder relationships with managers & senior managers , to identify actions to achieve improvements and monitor initiative impact
• Support other strategic projects as assigned to meet business needs
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• 3+ years of technical work experience using analytical tools and writing analytical reports
• 3+ years demonstrated ability to work with large datasets and distill analyses into relevant insights with a structured and systematic thought process
• Strong communication skills, verbal and written, around business reporting impact and requirements, as demonstrated by 5+ examples / projects of presenting analysis to Leadership (Director+)
• 3+ years experience in SQL, with the ability to filter, aggregate, and build CTEs, or proficiency in R or Python, including experience with Pandas, for loops, and statistical tests
• 3+ years experience developing dashboards and working with Looker, or other business intelligence/data visualization tools
• 3+ years experience, including proficiency in Google Sheets or Excel skills, with ability to use VLookup, nested if statements and connected Sheets
• 1+ years experience in healthcare, consulting, finance or the insurance industry

Bonus points:

• 2+ years experience in preparing healthcare analytics and reporting
• 2+ years experience managing value-based contracts at a payer or a provider organization (ACO, CIN, MSO etc.)
• Exposure to healthcare contract negotiations, risk adjustment, ACA marketplace, quality of care, and/or population health experience

Hi, we're Oscar. We're hiring a to join our Clinical Data Analytics 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 partner closely across the organization to identify and manage inefficiencies proactively in the business. You will support business units in scoping, analyzing and monitoring performance of key financial and utilization metrics in service of company goals. You will independently drives the scoping & execution of analytical requests, including working with stakeholders to define key questions, scope methodologies and results. You will be called upon to speak to prepared analysis both internally and externally.

You will report into the Senior Manager, Clinical Analytics.

Work Location: This is a remote position, open to candidates who reside in: Dallas, Texas. You will be fully remote; however, our approach to work may adapt over time. Future models could potentially involve a hybrid presence at the hub office associated with your metro area. #LI-Remote

Pay Transparency: The base pay for this role is: $91,659 - $120,303 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program, and annual performance bonuses.

Responsibilities:

• Responsible for owning insights generation and follow-up for a major business unit, serving as the first point of contract for Sr. Managers and Associate Directors
• Analyze data to support business teams in making better informed, data-driven decisions
• Use data to tell a story that non-technical colleagues will be able to understand, including packaging and presenting findings in a clear, concise and compelling manner
• Recognize the need to enhance essential operational and analytical dashboards, and define the requirements to enhance them as our user's needs evolve
• Identify opportunities to create models and tools that produce relevant insights to identify healthcare inefficiencies and generate insights to remove inefficiencies
• Collaborate across the organization, including owning stakeholder relationships with managers & senior managers , to identify actions to achieve improvements and monitor initiative impact
• Support other strategic projects as assigned to meet business needs
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• 3+ years of technical work experience using analytical tools and writing analytical reports
• 3+ years demonstrated ability to work with large datasets and distill analyses into relevant insights with a structured and systematic thought process
• Strong communication skills, verbal and written, around business reporting impact and requirements, as demonstrated by 5+ examples / projects of presenting analysis to Leadership (Director+)
• 3+ years experience in SQL, with the ability to filter, aggregate, and build CTEs, or proficiency in R or Python, including experience with Pandas, for loops, and statistical tests
• 3+ years experience developing dashboards and working with Looker, or other business intelligence/data visualization tools
• 3+ years experience, including proficiency in Google Sheets or Excel skills, with ability to use VLookup, nested if statements and connected Sheets
• 1+ years experience in healthcare, consulting, finance or the insurance industry

Bonus points:

• 2+ years experience in preparing healthcare analytics and reporting
• 2+ years experience managing value-based contracts at a payer or a provider organization (ACO, CIN, MSO etc.)
• Exposure to healthcare contract negotiations, risk adjustment, ACA marketplace, quality of care, and/or population health experience

Hi, we're Oscar. We're hiring a to join our Clinical Data Analytics 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 partner closely across the organization to identify and manage inefficiencies proactively in the business. You will support business units in scoping, analyzing and monitoring performance of key financial and utilization metrics in service of company goals. You will independently drives the scoping & execution of analytical requests, including working with stakeholders to define key questions, scope methodologies and results. You will be called upon to speak to prepared analysis both internally and externally.

You will report into the Senior Manager, Clinical Analytics.

Work Location: This is a remote position, open to candidates who reside in: Atlanta, Georgia. You will be fully remote; however, our approach to work may adapt over time. Future models could potentially involve a hybrid presence at the hub office associated with your metro area. #LI-Remote

Pay Transparency: The base pay for this role is: $91,659 - $120,303 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program, and annual performance bonuses.

Responsibilities:

• Responsible for owning insights generation and follow-up for a major business unit, serving as the first point of contract for Sr. Managers and Associate Directors
• Analyze data to support business teams in making better informed, data-driven decisions
• Use data to tell a story that non-technical colleagues will be able to understand, including packaging and presenting findings in a clear, concise and compelling manner
• Recognize the need to enhance essential operational and analytical dashboards, and define the requirements to enhance them as our user's needs evolve
• Identify opportunities to create models and tools that produce relevant insights to identify healthcare inefficiencies and generate insights to remove inefficiencies
• Collaborate across the organization, including owning stakeholder relationships with managers & senior managers , to identify actions to achieve improvements and monitor initiative impact
• Support other strategic projects as assigned to meet business needs
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• 3+ years of technical work experience using analytical tools and writing analytical reports
• 3+ years demonstrated ability to work with large datasets and distill analyses into relevant insights with a structured and systematic thought process
• Strong communication skills, verbal and written, around business reporting impact and requirements, as demonstrated by 5+ examples / projects of presenting analysis to Leadership (Director+)
• 3+ years experience in SQL, with the ability to filter, aggregate, and build CTEs, or proficiency in R or Python, including experience with Pandas, for loops, and statistical tests
• 3+ years experience developing dashboards and working with Looker, or other business intelligence/data visualization tools
• 3+ years experience, including proficiency in Google Sheets or Excel skills, with ability to use VLookup, nested if statements and connected Sheets
• 1+ years experience in healthcare, consulting, finance or the insurance industry

Bonus points:

• 2+ years experience in preparing healthcare analytics and reporting
• 2+ years experience managing value-based contracts at a payer or a provider organization (ACO, CIN, MSO etc.)
• Exposure to healthcare contract negotiations, risk adjustment, ACA marketplace, quality of care, and/or population health experience

Hi, we're Oscar. We're hiring an Associate, UM Regulatory Operations to join our Regulatory Operations 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 responsible for working cross functionally with business and technical Oscar stakeholders and representing the needs and interests of the department in company wide strategic initiatives and in solving business problems related to internal processes. This requires collecting and documenting business requirements, building and managing project plans, documenting key project decisions, managing project governance, applying frameworks, analyzing data, and developing and communicating risk mitigation strategies across disparate initiatives and stakeholders at the same time.

You will report into the Senior Manager, UM Regulatory Operations.

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.You will be fully remote; however, our approach to work may adapt over time. Future models could potentially involve a hybrid presence at the hub office associated with your metro area. #LI-Remote

Pay Transparency: The base pay for this role is: $87,188 - $118,434 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program, and annual performance bonuses.

Responsibilities:

• Lead the end-to-end management of cross-functional implementations/projects, including project plan creation, stakeholder engagement, managing cross-functional relationships to drive collaboration, edge case mitigation, and on-time completion
• Evaluate overall departmental performance by creating, gathering, analyzing and interpreting data and metrics as well as assisting in development of departmental metrics and implementation of mitigation strategies
• Collaboratively works with all relevant internal and external stakeholder groups to to interpret and apply new and evolving regulations, ensuring consistent understanding and accurate implementation across UM operations.
• Coordinate regulatory request management for the UM department, including market conduct exams, URA filings, license renewals, and Mental Health Parity (MHPAEA) compliance.
• Coordinates NCQA deliverables for UM standards
• Evaluates and drafts UM policy and procedures ensuring compliance within the UM program
• Mentor team members and promotes colleagues' growth and professional development
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• A bachelor's degree or 3+ years commensurate experience
• 3+ years of work experience in healthcare Utilization Management operations, health insurance, and/or related field
• 2+ years of experience supporting regulatory compliance activities, including Mental Health Parity (MHPAEA), market conduct exams, license renewals, NCQA surveys/accreditation, and other regulatory filings
• 2+ years of experience with end to end project management or process improvement initiatives
• 2+ years of experience in regulatory implementation and compliance
• 2+ years of experience in designing and improving workflows as well as standing up accompanying operating and technical procedures

Bonus points:

• 2+ years of experience using data software such as Excel, Microsoft Office, Google Sheets, GSuite
• Experience collaborating with legal, compliance, and cross-functional teams
• Experience with process improvement methodologies such as Lean, Six Sigma and/or Theory of constraints

Hi, we're Oscar. We're hiring a Senior Analyst, UM Regulatory Operations to join our UM Regulatory Operations 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 support the design, optimization, and implementation of processes and improvements to operations in support of achieving organizational goals. You will be responsible to support implementations for regulatory requirements, compliance initiatives, UM audits, and other projects, as needed.

You will report into the Senior Manager, UM Regulatory Operations.

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..You will be fully remote; however, our approach to work may adapt over time. Future models could potentially involve a hybrid presence at the hub office associated with your metro area. #LI-Remote

Pay Transparency: The base pay for this role is: $67,813 - $89,004 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program, and annual performance bonuses.

Responsibilities:

• Coordinate projects and processes to help support key regulatory and compliance milestones and deliverables
• Partner with leadership to implement regulations, support key state filings, and other projects
• Partner with cross-functional teams to ensure action plans and process improvements align with project goals, and participate in collaboration with peers and cross-functional stakeholders
• Support audit exams (NCQA, MHPAEA, State)
• Help identify risks; respond to and resolve compliance gaps through regulatory implementation and in response to audits and Corrective Action Plans
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• 1+ years of experience in healthcare audits, or accreditations supporting NCQA and/or regulatory compliance
• 1+ years of professional experience in utilization management, healthcare operations and/or compliance, or a related field
• 1+ years of experience in Adobe Acrobat, and Google Suite or Microsoft Office (Sheets/Excel, Docs/Word, Slides/Powerpoint, etc)
• 1+ years of experience with interdepartmental collaboration with stakeholders to drive projects

Bonus points:

• 1+ years of experience supporting state audits and exams
• ACA marketplace, utilization management, healthcare quality and compliance, or provider data experience
• Training or experience applying Continuous Process Improvement or Lean Six Sigma principles
• Experience with project coordination or management in a matrixed organization
• 1+ years of experience in developing and presenting information and recommendations

Hi, we're Oscar. We're hiring a Utilization Review Nurse to join our Utilization Review 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 perform frequent case reviews, check medical records and speak with care providers regarding treatment as needed. You will make recommendations regarding the appropriateness of care for identified diagnoses based on the research results for those conditions.

You will report into the Supervisor, Utilization Review.

Work Location: This is a remote position, open to candidates who reside in: Texas, Georgia, Arizona, and Florida. 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: $35.00 - $45.94 per hour. You are also eligible for employee benefits and monthly vacation accrual at a rate of 15 days per year.

Responsibilities:

• Complete medical necessity reviews and level of care reviews for requested services using clinical judgment and Oscar Clinical Guidelines, Milliman Care Guidelines
• Obtain the information necessary (via telephone and fax) to assess a member's clinical condition, and apply the appropriate evidence-based guidelines
• Meet required decision-making SLAs
• Refer members for further care engagement when needed
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC)
• Associate Degree or Bachelors Degree - Nursing or Graduate of Accredited School of Nursing
• MCG or InterQual tooling experience
• Ability to obtain additional state licenses to meet business needs
• 1+ year of utilization review experience in a managed care setting
• 1+ years of clinical experience (including at least 1+ year clinical practice in an acute care setting, i.e., ER or hospital)

Bonus points:

• BSN
• Previous experience conducting concurrent or inpatient reviews for a managed care plan

Hi, we're Oscar. We're hiring a Senior Analyst to join our Authorization Services Design and Configuration 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 architect of our medical management operations. In this role, you will design, configure, and optimize the workflows and business rules within our Utilization Management (UM) system to ensure seamless authorization processing. You will translate complex business requirements into automated logic, handle internal escalations to identify root causes and remediation pathways, and act as a subject matter expert to educate cross-functional partners on how our systems drive care decisions.

This is a technical and operational role that requires a systems thinker with a collaborative mindset who enjoys solving complex, systems level problems.

You will report into the Associate Director of Authorization Services.

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: $73,348 - $98,894 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program, and annual performance bonuses.

Responsibilities:

• Manage the configuration and maintenance of authorization workflows, rulesets, and automations within the UM platform.
• Translate business requirements into precise technical specifications, ensuring that business rules and logic are accurately represented, tested, and implemented.
• Investigate and resolve cross-functional escalations by performing root cause analysis on system behavior and configuration gaps.
• Proactively identify "friction points" in the authorization process and document formal opportunities for workflow improvement and automation.
• Act as the primary subject matter expert for the UM system, educating internal teams (Product, Clinical, Regulatory) on how configuration impacts operations and supports business needs.
• Develop testing protocols and execute test scenarios to validate expected system behavior and configuration accuracy. Lead corrective activities when system behavior deviates from expectations.
• Manage assigned caseloads and project tasks through effective dashboard management and prioritization.
• Maintain clear, comprehensive documentation of all business rules, technical specs, and workflow designs.
• Other duties as assigned

Requirements:

• 2+ years of experience in system configuration, business rules management, or technical workflow design.
• 2+ years of experience in a technical/operational role involving root-cause analysis and data troubleshooting.
• Intermediate to Advanced proficiency in Excel/Google Sheets (vlookups, pivot tables, and data manipulation).
• Proven ability to assess and comprehend end-to-end process impacts in complex technical environments.
• Strong communication skills with the ability to explain technical system logic to non-technical stakeholders.
• 1+ year working knowledge of within the healthcare industry (payer or provider).

Bonus points:

• Prior work experience in Prior Authorizations or Insurance Operations.
• 2+ years of proficiency in SQL, BigQuery, or similar database languages.
• Experience using project management and communication tools like JIRA, Linear, and Slack.
• Experience working with large datasets, data verification, and data management.

Hi, we're Oscar. We're hiring a Senior Analyst to join our Authorization Services Design and Configuration 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 architect of our medical management operations. In this role, you will design, configure, and optimize the workflows and business rules within our Utilization Management (UM) system to ensure seamless authorization processing. You will translate complex business requirements into automated logic, handle internal escalations to identify root causes and remediation pathways, and act as a subject matter expert to educate cross-functional partners on how our systems drive care decisions.

This is a technical and operational role that requires a systems thinker with a collaborative mindset who enjoys solving complex, systems level problems.

You will report into the Associate Director of Authorization Services.

Work Location: This position is based in our Tempe, Arizona 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: $67,813 - $89,004 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program, and annual performance bonuses.

Responsibilities:

• Manage the configuration and maintenance of authorization workflows, rulesets, and automations within the UM platform.
• Translate business requirements into precise technical specifications, ensuring that business rules and logic are accurately represented, tested, and implemented.
• Investigate and resolve cross-functional escalations by performing root cause analysis on system behavior and configuration gaps.
• Proactively identify "friction points" in the authorization process and document formal opportunities for workflow improvement and automation.
• Act as the primary subject matter expert for the UM system, educating internal teams (Product, Clinical, Regulatory) on how configuration impacts operations and supports business needs.
• Develop testing protocols and execute test scenarios to validate expected system behavior and configuration accuracy. Lead corrective activities when system behavior deviates from expectations.
• Manage assigned caseloads and project tasks through effective dashboard management and prioritization.
• Maintain clear, comprehensive documentation of all business rules, technical specs, and workflow designs.
• Other duties as assigned

Requirements:

• 2+ years of experience in system configuration, business rules management, or technical workflow design.
• 2+ years of experience in a technical/operational role involving root-cause analysis and data troubleshooting.
• Intermediate to Advanced proficiency in Excel/Google Sheets (vlookups, pivot tables, and data manipulation).
• Proven ability to assess and comprehend end-to-end process impacts in complex technical environments.
• Strong communication skills with the ability to explain technical system logic to non-technical stakeholders.
• 1+ year working knowledge of within the healthcare industry (payer or provider).

Bonus points:

• Prior work experience in Prior Authorizations or Insurance Operations.
• 2+ years of proficiency in SQL, BigQuery, or similar database languages.
• Experience using project management and communication tools like JIRA, Linear, and Slack.
• Experience working with large datasets, data verification, and data management.

Hi, we're Oscar. We're hiring a Senior Analyst to join our Authorization Services Design and Configuration 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 architect of our medical management operations. In this role, you will design, configure, and optimize the workflows and business rules within our Utilization Management (UM) system to ensure seamless authorization processing. You will translate complex business requirements into automated logic, handle internal escalations to identify root causes and remediation pathways, and act as a subject matter expert to educate cross-functional partners on how our systems drive care decisions.

This is a technical and operational role that requires a systems thinker with a collaborative mindset who enjoys solving complex, systems level problems.

You will report into the Associate Director of Authorization Services.

Work Location: This is a remote position, open to candidates who reside in: Dallas, Texas. You will be fully remote; however, our approach to work may adapt over time. Future models could potentially involve a hybrid presence at the hub office associated with your metro area. #LI-Remote

Pay Transparency: The base pay for this role is: $67,813 - $89,004 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program, and annual performance bonuses.

Responsibilities:

• Manage the configuration and maintenance of authorization workflows, rulesets, and automations within the UM platform.
• Translate business requirements into precise technical specifications, ensuring that business rules and logic are accurately represented, tested, and implemented.
• Investigate and resolve cross-functional escalations by performing root cause analysis on system behavior and configuration gaps.
• Proactively identify "friction points" in the authorization process and document formal opportunities for workflow improvement and automation.
• Act as the primary subject matter expert for the UM system, educating internal teams (Product, Clinical, Regulatory) on how configuration impacts operations and supports business needs.
• Develop testing protocols and execute test scenarios to validate expected system behavior and configuration accuracy. Lead corrective activities when system behavior deviates from expectations.
• Manage assigned caseloads and project tasks through effective dashboard management and prioritization.
• Maintain clear, comprehensive documentation of all business rules, technical specs, and workflow designs.
• Other duties as assigned

Requirements:

• 2+ years of experience in system configuration, business rules management, or technical workflow design.
• 2+ years of experience in a technical/operational role involving root-cause analysis and data troubleshooting.
• Intermediate to Advanced proficiency in Excel/Google Sheets (vlookups, pivot tables, and data manipulation).
• Proven ability to assess and comprehend end-to-end process impacts in complex technical environments.
• Strong communication skills with the ability to explain technical system logic to non-technical stakeholders.
• 1+ year working knowledge of within the healthcare industry (payer or provider).

Bonus points:

• Prior work experience in Prior Authorizations or Insurance Operations.
• 2+ years of proficiency in SQL, BigQuery, or similar database languages.
• Experience using project management and communication tools like JIRA, Linear, and Slack.
• Experience working with large datasets, data verification, and data management.
•  

Hi, we're Oscar. We're hiring a Senior Analyst to join our Authorization Services Design and Configuration 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 architect of our medical management operations. In this role, you will design, configure, and optimize the workflows and business rules within our Utilization Management (UM) system to ensure seamless authorization processing. You will translate complex business requirements into automated logic, handle internal escalations to identify root causes and remediation pathways, and act as a subject matter expert to educate cross-functional partners on how our systems drive care decisions.

This is a technical and operational role that requires a systems thinker with a collaborative mindset who enjoys solving complex, systems level problems.

You will report into the Associate Director of Authorization Services.

Work Location: This is a remote position, open to candidates who reside in: Atlanta, Georgia. You will be fully remote; however, our approach to work may adapt over time. Future models could potentially involve a hybrid presence at the hub office associated with your metro area. #LI-Remote

Pay Transparency: The base pay for this role is: $67,813 - $89,004 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program, and annual performance bonuses.

Responsibilities:

• Manage the configuration and maintenance of authorization workflows, rulesets, and automations within the UM platform.
• Translate business requirements into precise technical specifications, ensuring that business rules and logic are accurately represented, tested, and implemented.
• Investigate and resolve cross-functional escalations by performing root cause analysis on system behavior and configuration gaps.
• Proactively identify "friction points" in the authorization process and document formal opportunities for workflow improvement and automation.
• Act as the primary subject matter expert for the UM system, educating internal teams (Product, Clinical, Regulatory) on how configuration impacts operations and supports business needs.
• Develop testing protocols and execute test scenarios to validate expected system behavior and configuration accuracy. Lead corrective activities when system behavior deviates from expectations.
• Manage assigned caseloads and project tasks through effective dashboard management and prioritization.
• Maintain clear, comprehensive documentation of all business rules, technical specs, and workflow designs.
• Other duties as assigned

Requirements:

• 2+ years of experience in system configuration, business rules management, or technical workflow design.
• 2+ years of experience in a technical/operational role involving root-cause analysis and data troubleshooting.
• Intermediate to Advanced proficiency in Excel/Google Sheets (vlookups, pivot tables, and data manipulation).
• Proven ability to assess and comprehend end-to-end process impacts in complex technical environments.
• Strong communication skills with the ability to explain technical system logic to non-technical stakeholders.
• 1+ year working knowledge of within the healthcare industry (payer or provider).

Bonus points:

• Prior work experience in Prior Authorizations or Insurance Operations.
• 2+ years of proficiency in SQL, BigQuery, or similar database languages.
• Experience using project management and communication tools like JIRA, Linear, and Slack.
• Experience working with large datasets, data verification, and data management.

Hi, we're Oscar. We're hiring a Care Navigation Nurse to join our Care Navigation 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 requires extensive clinical knowledge and initiative to perform in-depth research, problem-solving, and decision-making to source and route to medically appropriate care, verify network gaps, escalate issues to appropriate stakeholders, guide the Care Navigation team in searches, and improve member experience. Additionally, you will provide ongoing clinical education to non-clinical teams to provide a strong foundation to be utilized in their workings with members.

You will report into the Clinical Care Navigation Lead.

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: $39.28 - $45.94 per hour. You are also eligible for employee benefits and monthly vacation accrual at a rate of 15 days per year.

Responsibilities:

• Help coordinate care across a variety of settings (inpatient, outpatient, post acute, ER, home care)
• Actively reach out to members undergoing difficult health challenges and develop care plans
• Proactively reach out to hospital case managers to assist with discharge planning
• Communicate with members via phone or secure messaging to provide education on health conditions, new medications, and procedures.
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate unrestricted RN license
• Ability to obtain additional state licenses to meet business needs
• 3+ years of clinical experience to include hospital, outpatient or community based care management
• 3+ years of experience in Care Coordination and Navigation

Bonus points:

• BSN
• Working knowledge of Milliman Guidelines
• CCM Certification
• Behavioral Health experience

Hi, we're Oscar. We're hiring an Associate, UM Regulatory Operations to join our Regulatory Operations 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 responsible for working cross functionally with business and technical Oscar stakeholders and representing the needs and interests of the department in company wide strategic initiatives and in solving business problems related to internal processes. This requires collecting and documenting business requirements, building and managing project plans, documenting key project decisions, managing project governance, applying frameworks, analyzing data, and developing and communicating risk mitigation strategies across disparate initiatives and stakeholders at the same time.

You will report into the Senior Manager, UM Regulatory Operations.

Work Location: This position is based in our Tempe, Arizona 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: $87,188 - $118,434 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program, and annual performance bonuses.

Responsibilities:

• Lead the end-to-end management of cross-functional implementations/projects, including project plan creation, stakeholder engagement, managing cross-functional relationships to drive collaboration, edge case mitigation, and on-time completion
• Evaluate overall departmental performance by creating, gathering, analyzing and interpreting data and metrics as well as assisting in development of departmental metrics and implementation of mitigation strategies
• Collaboratively works with all relevant internal and external stakeholder groups to to interpret and apply new and evolving regulations, ensuring consistent understanding and accurate implementation across UM operations.
• Coordinate regulatory request management for the UM department, including market conduct exams, URA filings, license renewals, and Mental Health Parity (MHPAEA) compliance.
• Coordinates NCQA deliverables for UM standards
• Evaluates and drafts UM policy and procedures ensuring compliance within the UM program
• Mentor team members and promotes colleagues' growth and professional development
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• A bachelor's degree or 3+ years commensurate experience
• 3+ years of work experience in healthcare Utilization Management operations, health insurance, and/or related field
• 2+ years of experience supporting regulatory compliance activities, including Mental Health Parity (MHPAEA), market conduct exams, license renewals, NCQA surveys/accreditation, and other regulatory filings
• 2+ years of experience with end to end project management or process improvement initiatives
• 2+ years of experience in regulatory implementation and compliance
• 2+ years of experience in designing and improving workflows as well as standing up accompanying operating and technical procedures

Bonus points:

• 2+ years of experience using data software such as Excel, Microsoft Office, Google Sheets, GSuite
• Experience collaborating with legal, compliance, and cross-functional teams
• Experience with process improvement methodologies such as Lean, Six Sigma and/or Theory of constraints

Hi, we're Oscar. We're hiring an Associate, UM Regulatory Operations to join our Regulatory Operations 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 responsible for working cross functionally with business and technical Oscar stakeholders and representing the needs and interests of the department in company wide strategic initiatives and in solving business problems related to internal processes. This requires collecting and documenting business requirements, building and managing project plans, documenting key project decisions, managing project governance, applying frameworks, analyzing data, and developing and communicating risk mitigation strategies across disparate initiatives and stakeholders at the same time.

You will report into the Senior Manager, UM Regulatory 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: $96,876 - $127,149 per year. YYou are also eligible for employee benefits, participation in Oscar's unlimited vacation program, and annual performance bonuses.

Responsibilities:

• Lead the end-to-end management of cross-functional implementations/projects, including project plan creation, stakeholder engagement, managing cross-functional relationships to drive collaboration, edge case mitigation, and on-time completion
• Evaluate overall departmental performance by creating, gathering, analyzing and interpreting data and metrics as well as assisting in development of departmental metrics and implementation of mitigation strategies
• Collaboratively works with all relevant internal and external stakeholder groups to to interpret and apply new and evolving regulations, ensuring consistent understanding and accurate implementation across UM operations.
• Coordinate regulatory request management for the UM department, including market conduct exams, URA filings, license renewals, and Mental Health Parity (MHPAEA) compliance.
• Coordinates NCQA deliverables for UM standards
• Evaluates and drafts UM policy and procedures ensuring compliance within the UM program
• Mentor team members and promotes colleagues' growth and professional development
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• A bachelor's degree or 3+ years commensurate experience
• 3+ years of work experience in healthcare Utilization Management operations, health insurance, and/or related field
• 2+ years of experience supporting regulatory compliance activities, including Mental Health Parity (MHPAEA), market conduct exams, license renewals, NCQA surveys/accreditation, and other regulatory filings
• 2+ years of experience with end to end project management or process improvement initiatives
• 2+ years of experience in regulatory implementation and compliance
• 2+ years of experience in designing and improving workflows as well as standing up accompanying operating and technical procedures

Bonus points:

• 2+ years of experience using data software such as Excel, Microsoft Office, Google Sheets, GSuite
• Experience collaborating with legal, compliance, and cross-functional teams
• Experience with process improvement methodologies such as Lean, Six Sigma and/or Theory of constraints

Hi, we're Oscar. We're hiring a Complex Case Management Nurse to join our CCM 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 educate members on improving health outcomes, assist with transitions from care settings, participate in process improvement and other pilot programs as they arise, and work with support teams to ensure exceptional care for our members.

You will report into the Associate Director, Clinical.

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: $39.28 - $45.94 per hour. You are also eligible for employee benefits and monthly vacation accrual at a rate of 15 days per year.

Responsibilities:

• Assist in the coordination of care across a variety of settings (inpatient, outpatient, post acute, ER, home care)
• Actively reach out to members undergoing difficult health challenges and develop care plans
• Proactively reach out to hospital case managers to assist with discharge planning
• Communicate with members via phone or secure messaging to provide education on health conditions, new medications, and procedures
• Ensure compliance with all CCM NCQA standards in day to day practice and workflows.
• Compliance with all applicable laws and regulations
• Other duties as assigned
• Requirements:

• Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate unrestricted RN license
• Ability to obtain additional state licenses to meet business needs
• 2+ years of clinical experience to include payer, hospital, outpatient or community based care management
• 1+ years of experience in Care Coordination and Navigation

Bonus points:

• CCM Certification
• NCQA knowledge and accreditation experience
• Bilingual in spanish and or creole reading, writing, speaking
• BSN
• Working knowledge of Milliman Guidelines

Hi, we're Oscar. We're hiring a Senior Analyst, UM Regulatory Operations to join our UM Regulatory Operations 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 support the design, optimization, and implementation of processes and improvements to operations in support of achieving organizational goals. You will be responsible to support implementations for regulatory requirements, compliance initiatives, UM audits, and other projects, as needed.

You will report into the Senior Manager, UM Regulatory 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: $75,348 - $98,894 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program, and annual performance bonuses.

Responsibilities:

• Coordinate projects and processes to help support key regulatory and compliance milestones and deliverables
• Partner with leadership to implement regulations, support key state filings, and other projects
• Partner with cross-functional teams to ensure action plans and process improvements align with project goals, and participate in collaboration with peers and cross-functional stakeholders
• Support audit exams (NCQA, MHPAEA, State)
• Help identify risks; respond to and resolve compliance gaps through regulatory implementation and in response to audits and Corrective Action Plans
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• 1+ years of experience in healthcare audits, or accreditations supporting NCQA and/or regulatory compliance 
• 1+ years of professional experience in utilization management, healthcare operations and/or compliance, or a related field
• 1+ years of experience in Adobe Acrobat, and Google Suite or Microsoft Office (Sheets/Excel, Docs/Word, Slides/Powerpoint, etc)
• 1+ years of experience with interdepartmental collaboration with stakeholders to drive projects

Bonus points:

• 1+ years of experience supporting state audits and exams
• ACA marketplace, utilization management, healthcare quality and compliance, or provider data experience
• Training or experience applying Continuous Process Improvement or Lean Six Sigma principles
• Experience with project coordination or management in a matrixed organization
• 1+ years of experience in developing and presenting information and recommendations

Hi, we're Oscar. We're hiring a Senior Analyst, UM Regulatory Operations to join our UM Regulatory Operations 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 support the design, optimization, and implementation of processes and improvements to operations in support of achieving organizational goals. You will be responsible to support implementations for regulatory requirements, compliance initiatives, UM audits, and other projects, as needed.

You will report into the Senior Manager, UM Regulatory Operations.

Work Location: This position is based in our Tempe, Arizona 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: $67,813 - $89,004 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program, and annual performance bonuses.

Responsibilities:

• Coordinate projects and processes to help support key regulatory and compliance milestones and deliverables
• Partner with leadership to implement regulations, support key state filings, and other projects
• Partner with cross-functional teams to ensure action plans and process improvements align with project goals, and participate in collaboration with peers and cross-functional stakeholders
• Support audit exams (NCQA, MHPAEA, State)
• Help identify risks; respond to and resolve compliance gaps through regulatory implementation and in response to audits and Corrective Action Plans
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• 1+ years of experience in healthcare audits, or accreditations supporting NCQA and/or regulatory compliance 
• 1+ years of professional experience in utilization management, healthcare operations and/or compliance, or a related field
• 1+ years of experience in Adobe Acrobat, and Google Suite or Microsoft Office (Sheets/Excel, Docs/Word, Slides/Powerpoint, etc)
• 1+ years of experience with interdepartmental collaboration with stakeholders to drive projects

Bonus points:

• 1+ years of experience supporting state audits and exams
• ACA marketplace, utilization management, healthcare quality and compliance, or provider data experience
• Training or experience applying Continuous Process Improvement or Lean Six Sigma principles
• Experience with project coordination or management in a matrixed organization
• 1+ years of experience in developing and presenting information and recommendations

Hi, we're Oscar. We're hiring a Manager, Strategic Value & Investment Analysis to join our UM Strategy 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 heavily embedded in the financial oversight of the UM Strategy team. In this role, you are responsible for quantifying and communicating the financial impact of all UM initiatives. Your core goal is to ensure that strategic investments translate into measurable, defensible affordability outcomes. You will serve as the primary liaison between the UM business unit and the Medical Economics/Finance departments to ensure all investments are accurately sized and tracked.

You will report into the Director, UM Authorization Strategy.

Work Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois; Iowa; Kansas; Michigan; Missouri; Nebraska; New Jersey; North Carolina; Ohio; Oklahoma; Pennsylvania; South Carolina; Tennessee; Texas; 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: $105,808 - $138,886 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program, and annual performance bonuses.

Responsibilities:

• Build complex financial modeling and lead the design and development of sound financial models to size the impact of UM and affordability strategies. Ensure alignment with corporate savings pipelines.
• Represent the UM department within the broader organization's financial workstreams, ensuring UM initiatives are prioritized and recognized in the corporate savings pipeline.
• Establish and maintain strong relationships with the Medical Economics and Data Science teams to develop vetted methodologies for tracking ROI.
• Own the "Source of Truth" for the department's value tracking. You will monitor the performance of active initiatives and provide monthly "True-Up" reports comparing projected savings to actualized results. Develop methods to measure actual performance against expected benefits.
• Build and maintain strong relationships with Medical Economics, Data Science, and Clinical leadership. Translate complex data into "executive-ready" narratives to influence enterprise-wide decision-making.
• Create data-driven frameworks to help leadership navigate ambiguity and make informed decisions on new strategic investments based on risk adjustment and Medical Loss Ratio (MLR) impact.
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• 4+ years of experience of experience in management consulting, financial strategic analysis, or healthcare corporate strategy.
• 3+ years of experience in delivering projects / programs
• Strong understanding of the ACA (Individual/Small Group) business model, including how UM impacts Risk Adjustment and Medical Loss Ratio (MLR).
• 3+ years of expertise in financial modeling, business case development, and cost-benefit analysis.
• Healthcare experience (Health Insurance, Health Systems, or Healthcare Consulting)

Bonus points:

• Experience with Medical Economics or Actuarial Science
• Advanced proficiency in SQL and Excel is required. Experience with data visualization tools (Looker) is highly preferred.
• Experience using data and metrics to drive improvements in programs  
• Experience / background in a fast-paced operations environment 
• Successfully executed enterprise-wide initiatives: defined project plans, coordinated resources, managed implementation activities, and developed all processes associated with program rollout and ongoing support
• Master’s Degree

Hi, we're Oscar. We're hiring a UM Program Operations Manager to join our UM Strategy 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 of UM Program Operations is the "Execution Engine" of the UM Strategy team. While our strategists identify what we should do, you own the how. You are responsible for the flawless execution of high-impact programs like Gold Carding, Provider Incentive Programs, and the maintenance of our Prior Authorization (PA) List. You will ensure that every program is operationally sound, regulatory compliant, and scales effectively as our footprint expands.

You will report into the Director, UM Authorization Strategy.

Work Location:This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois; Iowa; Kansas; Michigan; Missouri; Nebraska; New Jersey; North Carolina; Ohio; Oklahoma; Pennsylvania; South Carolina; Tennessee; Texas; 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: $105,808 - $138,886 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program, and annual performance bonuses.

Responsibilities:

• Lead the end-to-end execution and refresh cycles for "Gold Card" and "Provider Incentive" programs. This includes managing provider entry/exit criteria, coordinating the clinical audit framework, and ensuring accurate provider status updates.
• Act as the primary owner of the "Source of Truth" for the Prior Authorization list. You will lead the cross-functional governance process to ensure code additions, removals, and modifications are clinically adherent and accurately reflected across all internal systems and public-facing documents.
• Ensure all UM programs meet state and federal mandates, including emerging "Gold Card" legislation and transparency requirements. You will be the team's point of contact for Legal and Compliance audits.
• Develop and maintain the Standard Operating Procedures (SOPs) for net-new initiatives. You ensure that as the team innovates, the operational "blueprints" exist to make those innovations repeatable.
• Drive the recurring refresh cycles for auto-approval rules and provider incentive programs, ensuring they remain current with shifting clinical guidelines and medical policies.
• Lead the end-to-end management of cross-functional implementations/projects, including project plan creation, stakeholder engagement, managing cross-functional relationships to drive collaboration, edge case mitigation, and on-time completion.
• Evaluate overall departmental performance by creating, gathering, analyzing and interpreting data and metrics as well as assisting in development of departmental metrics and implementation of mitigation strategies.
• Collaboratively works with all relevant internal and external stakeholder groups to formulate proactive implementation, communications, and program strategies for successful change management and risk mitigation initiatives
• May oversee team members directly as well as mentors team members and promotes colleagues' growth and professional development
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• 4+ years of experience in program management
• 3+ years of experience in delivering projects / programs
• 2+ years of experience in managing prior authorization list process (updates, coordination)
• Experience in payer/health insurance

Bonus points:

• Experience using data and metrics to drive improvements in programs
• Experience / background in a fast-paced operations environment
• Experience managing Gold Card programs and updates
• Experience managing the Prior Authorization List process
• Successfully executed enterprise-wide initiatives: defined project plans, coordinated resources, managed implementation activities, and developed all processes associated with program rollout and ongoing support
• Master's Degree
• PMP Certifications or Program Management Certifications
• Lean/Six Sigma Certifications
• Healthcare experience (Health Insurance, Health Systems, or Healthcare Consulting)

Hi, we're Oscar. We're hiring a Medical Director to join our Clinical Affairs 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 build and oversee the Clinical Policy, Regulatory, and Compliance functions within the Office of Clinical Affairs. You will ensure our clinical operations meet healthcare laws and standards, develop and maintain regulatory policies, manage compliance risks, and guide policy-related submissions. You will advise senior leadership and work closely with teams across the organization to ensure clinical operations align with policy and regulatory intent.

You will report into the VP, Clinical Affairs

Work Location: You must reside in one of the following states: Arizona, California, Colorado, Connecticut, D.C., Florida, Georgia, Illinois, Iowa, Maryland, Massachusetts, Michigan, New Hampshire, New Jersey, New Mexico, New York City, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, Tennessee, Texas, or Utah. Note, this list of states is subject to change. #LI-Remote

Pay Transparency: The base pay for this role is: $218,592 - $286,902 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 and grow the Clinical Policy & Regulatory Affairs team.
• Build and manage processes that ensure clinical policy compliance and quality.
• Develop and maintain BIPs, SOPs, and other clinical policy documents aligned with QMS.
• Serve as a regulatory compliance expert and maintain strong relationships with key clinical teams.
• Deliver executive briefings on regulatory and policy impacts.
• Advise the CMO and senior leaders on compliance risks and strategy.
• Support interactions with federal and state regulators (FDA, CMS, state DOI).
• Oversee the Clinical Coding Center of Excellence and clinical credentialing.
• Promote a culture of compliance through training and education.
• Collaborate effectively with stakeholders across the organization.

Requirements:

• Active, unrestricted MD or DO license
• 10+ years of experience in healthcare or the health insurance industry
• 5+ years of experience in clinical policy compliance or clinical regulatory/government affairs
• 5+ years applying state and federal health insurance laws and regulations (Marketplace, MA, reporting, and audit requirements)
• 5+ years preparing and presenting reports to boards of directors
• 5+ year of team leadership and people development experience

Bonus points:

• JD or other legal training/certification
• Experience with ACA or commercial health plans
• Experience working in a fast-paced, collaborative environment

Hi, we're Oscar. We're hiring a Manager, Strategic Value & Investment Analysis to join our UM Strategy 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 heavily embedded in the financial oversight of the UM Strategy team. You are responsible for quantifying and communicating the financial impact of all UM initiatives. Your core goal is to ensure that strategic investments translate into measurable, defensible affordability outcomes. You will be the primary liaison between the UM business unit and the Medical Economics/Finance departments to ensure all investments are accurately sized and tracked.

You will report into the Director, UM Authorization Strategy.

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: $117,576 - $154,318 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program, and annual performance bonuses.

Responsibilities:

• Build complex financial modeling and lead the design and development of sound financial models to size the impact of UM and affordability strategies. Ensure alignment with corporate savings pipelines.
• Represent the UM department within the broader organization's financial workstreams, ensuring UM initiatives are prioritized and recognized in the corporate savings pipeline.
• Establish and maintain strong relationships with the Medical Economics and Data Science teams to develop vetted methodologies for tracking ROI.
• Own the "Source of Truth" for the department's value tracking. You will monitor the performance of active initiatives and provide monthly "True-Up" reports comparing projected savings to actualized results. Develop methods to measure actual performance against expected benefits.
• Build and maintain strong relationships with Medical Economics, Data Science, and Clinical leadership. Translate complex data into "executive-ready" narratives to influence enterprise-wide decision-making.
• Create data-driven frameworks to help leadership navigate ambiguity and make informed decisions on new strategic investments based on risk adjustment and Medical Loss Ratio (MLR) impact.
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• 4+ years of experience of experience in management consulting, financial strategic analysis, or healthcare corporate strategy.
• 3+ years of experience in delivering projects / programs
• Strong understanding of the ACA (Individual/Small Group) business model, including how UM impacts Risk Adjustment and Medical Loss Ratio (MLR).
• 3+ years of expertise in financial modeling, business case development, and cost-benefit analysis.
• Healthcare experience (Health Insurance, Health Systems, or Healthcare Consulting)

Bonus points:

• Experience with Medical Economics or Actuarial Science
• Advanced proficiency in SQL and Excel is required. Experience with data visualization tools (Looker)
• Experience using data and metrics to drive improvements in programs
• Experience / background in a fast-paced operations environment
• Successfully executed enterprise-wide initiatives: defined project plans, coordinated resources, managed implementation activities, and developed all processes associated with program rollout and ongoing support
• Master's Degree
• Lean/Six Sigma Certifications

Hi, we're Oscar. We're hiring a UM Program Operations Manager to join our UM Strategy 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 of UM Program Operations is the "Execution Engine" of the UM Strategy team. While our strategists identify what we should do, you own the how. You are responsible for the flawless execution of high-impact programs like Gold Carding, Provider Incentive Programs, and the maintenance of our Prior Authorization (PA) List. You will ensure that every program is operationally sound, regulatory compliant, and scales effectively as our footprint expands.

You will report into the Director, UM Authorization Strategy.

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: $117,576 - $154,318 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program, and annual performance bonuses.

Responsibilities:

• Lead the end-to-end execution and refresh cycles for "Gold Card" and "Provider Incentive" programs. This includes managing provider entry/exit criteria, coordinating the clinical audit framework, and ensuring accurate provider status updates.
• Act as the primary owner of the "Source of Truth" for the Prior Authorization list. You will lead the cross-functional governance process to ensure code additions, removals, and modifications are clinically adherent and accurately reflected across all internal systems and public-facing documents.
• Ensure all UM programs meet state and federal mandates, including emerging "Gold Card" legislation and transparency requirements. You will be the team's point of contact for Legal and Compliance audits.
• Develop and maintain the Standard Operating Procedures (SOPs) for net-new initiatives. You ensure that as the team innovates, the operational "blueprints" exist to make those innovations repeatable.
• Drive the recurring refresh cycles for auto-approval rules and provider incentive programs, ensuring they remain current with shifting clinical guidelines and medical policies.
• Lead the end-to-end management of cross-functional implementations/projects, including project plan creation, stakeholder engagement, managing cross-functional relationships to drive collaboration, edge case mitigation, and on-time completion.
• Evaluate overall departmental performance by creating, gathering, analyzing and interpreting data and metrics as well as assisting in development of departmental metrics and implementation of mitigation strategies.
• Collaboratively works with all relevant internal and external stakeholder groups to formulate proactive implementation, communications, and program strategies for successful change management and risk mitigation initiatives
• May oversee team members directly as well as mentors team members and promotes colleagues' growth and professional development
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• 4+ years of experience in program management
• 3+ years of experience in delivering projects / programs
• 2+ years of experience in managing prior authorization list process (updates, coordination)
• Experience in payer/health insurance

Bonus points:

• Experience using data and metrics to drive improvements in programs  
• Experience / background in a fast-paced operations environment 
• Experience managing Gold Card programs and updates
• Experience managing the Prior Authorization List process
• Successfully executed enterprise-wide initiatives: defined project plans, coordinated resources, managed implementation activities, and developed all processes associated with program rollout and ongoing support
• Master’s Degree
• PMP Certifications or Program Management Certifications
• Lean/Six Sigma Certifications
• Healthcare experience (Health Insurance, Health Systems, or Healthcare Consulting)

Hi, we're Oscar. We're hiring a UM Program Operations Manager to join our UM Strategy 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 of UM Program Operations is the "Execution Engine" of the UM Strategy team. While our strategists identify what we should do, you own the how. You are responsible for the flawless execution of high-impact programs like Gold Carding, Provider Incentive Programs, and the maintenance of our Prior Authorization (PA) List. You will ensure that every program is operationally sound, regulatory compliant, and scales effectively as our footprint expands.

You will report into the Director, UM Authorization Strategy.

Work Location: This position is based in our Tempe, Arizona 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: $105,808 - $138,886 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program, and annual performance bonuses.

Responsibilities:

• Lead the end-to-end execution and refresh cycles for "Gold Card" and "Provider Incentive" programs. This includes managing provider entry/exit criteria, coordinating the clinical audit framework, and ensuring accurate provider status updates.
• Act as the primary owner of the "Source of Truth" for the Prior Authorization list. You will lead the cross-functional governance process to ensure code additions, removals, and modifications are clinically adherent and accurately reflected across all internal systems and public-facing documents.
• Ensure all UM programs meet state and federal mandates, including emerging "Gold Card" legislation and transparency requirements. You will be the team's point of contact for Legal and Compliance audits.
• Develop and maintain the Standard Operating Procedures (SOPs) for net-new initiatives. You ensure that as the team innovates, the operational "blueprints" exist to make those innovations repeatable.
• Drive the recurring refresh cycles for auto-approval rules and provider incentive programs, ensuring they remain current with shifting clinical guidelines and medical policies.
• Lead the end-to-end management of cross-functional implementations/projects, including project plan creation, stakeholder engagement, managing cross-functional relationships to drive collaboration, edge case mitigation, and on-time completion.
• Evaluate overall departmental performance by creating, gathering, analyzing and interpreting data and metrics as well as assisting in development of departmental metrics and implementation of mitigation strategies.
• Collaboratively works with all relevant internal and external stakeholder groups to formulate proactive implementation, communications, and program strategies for successful change management and risk mitigation initiatives
• May oversee team members directly as well as mentors team members and promotes colleagues' growth and professional development
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• 4+ years of experience in program management
• 3+ years of experience in delivering projects / programs
• 2+ years of experience in managing prior authorization list process (updates, coordination)
• Experience in payer/health insurance

Bonus points:

• Experience using data and metrics to drive improvements in programs
• Experience / background in a fast-paced operations environment
• Experience managing Gold Card programs and updates
• Experience managing the Prior Authorization List process
• Successfully executed enterprise-wide initiatives: defined project plans, coordinated resources, managed implementation activities, and developed all processes associated with program rollout and ongoing support
• Master's Degree
• PMP Certifications or Program Management Certifications
• Lean/Six Sigma Certifications
• Healthcare experience (Health Insurance, Health Systems, or Healthcare Consulting)

Hi, we're Oscar. We're hiring a Manager, Strategic Value & Investment Analysis to join our UM Strategy 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 heavily embedded in the financial oversight of the UM Strategy team. You are responsible for quantifying and communicating the financial impact of all UM initiatives. Your core goal is to ensure that strategic investments translate into measurable, defensible affordability outcomes. You will serve as the primary liaison between the UM business unit and the Medical Economics/Finance departments to ensure all investments are accurately sized and tracked.

You will report into the Director, UM Authorization Strategy.

Work Location: This position is based in our Tempe, Arizona 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: $105,808 - $138,886 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program, and annual performance bonuses.

Responsibilities:

• Build complex financial modeling and lead the design and development of sound financial models to size the impact of UM and affordability strategies. Ensure alignment with corporate savings pipelines.
• Represent the UM department within the broader organization's financial workstreams, ensuring UM initiatives are prioritized and recognized in the corporate savings pipeline.
• Establish and maintain strong relationships with the Medical Economics and Data Science teams to develop vetted methodologies for tracking ROI.
• Own the "Source of Truth" for the department's value tracking. You will monitor the performance of active initiatives and provide monthly "True-Up" reports comparing projected savings to actualized results. Develop methods to measure actual performance against expected benefits.
• Build and maintain strong relationships with Medical Economics, Data Science, and Clinical leadership. Translate complex data into "executive-ready" narratives to influence enterprise-wide decision-making.
• Create data-driven frameworks to help leadership navigate ambiguity and make informed decisions on new strategic investments based on risk adjustment and Medical Loss Ratio (MLR) impact.
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• 4+ years of experience of experience in management consulting, financial strategic analysis, or healthcare corporate strategy.
• 3+ years of experience in delivering projects / programs
• Strong understanding of the ACA (Individual/Small Group) business model, including how UM impacts Risk Adjustment and Medical Loss Ratio (MLR).
• 3+ years of expertise in financial modeling, business case development, and cost-benefit analysis.
• Healthcare experience (Health Insurance, Health Systems, or Healthcare Consulting)

Bonus points:

• Experience with Medical Economics or Actuarial Science
• Advanced proficiency in SQL and Excel is required. Experience with data visualization tools (Looker) is highly preferred.
• Experience using data and metrics to drive improvements in programs
• Experience / background in a fast-paced operations environment
• Successfully executed enterprise-wide initiatives: defined project plans, coordinated resources, managed implementation activities, and developed all processes associated with program rollout and ongoing support
• Master's Degree