Manager, Pharmacy Policy

Hi, we're Oscar. We're hiring a Manager to join our Clinical Policy team.

Oscar is the first health insurance company built around a full stack technology platform and a 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 help Oscar develop and review our policies given the fast pace of changes in medical literature and standards. You are responsible for our growing pharmacy policy program and driving high quality, cost-effective decision-making. You will play an essential part in our clinical organization to ensure our members receive high quality care.

You will report to the Senior Manager, Clinical Policy Development.

Work Location:

Oscar is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture and our mission.

If you live within commutable distance to our New York City office (in Hudson Square), our Tempe office (off the 101 at University Dr), or our Los Angeles office (in Marina Del Rey), you will be expected to come into the office at least two days each week. Otherwise, this is a remote / work-from-home role.

You must reside in one of the following states: Alabama, Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, Virginia, Washington, or Washington, D.C. Note, this list of states is subject to change. #LI-Remote

Pay Transparency:

The base pay for this role is: $131,200 - $172,200 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program, and annual performance bonuses.

Responsibilities

• Be accountable for the end-to-end process for development and review of pharmacy and medical drug guidelines and lead a team of contracted and/or matrixed reports to ensure timely review and submission of guideline updates in close partnership with our Pharmacy Operations team.
• Take the lead in drafting, obtaining approval, and maintaining pharmaceutical and medical drug policies based on current clinical evidence and nationally-recognized standards
• Manage direct, contracted, and matrixed team members
• Responsible for ensuring processes and policies are streamlined and adhere to larger departmental strategy.
• Prepare and present all materials for executive external view and feedback. Summarize changes and track evolution of pharmacy policy changes to support audit functions. Effectively communicates and presents results and recommendations across disciplines.
• Responsible for high-complexity reviews that require extensive up to date industry expertise or contextual knowledge.
• Partner with vendors to ensure accuracy of pharmacy code edits in claims system and prior authorization tooling and take an active role in policy customizations
• Maintain high levels of subject matter expertise on pharmaceutical pipeline trends, approvals, and changes in evidentiary standards. Track evidence submissions and feedback on policies, and prioritize policy updates
• Develop an in-depth understanding of regulatory and quality requirements applicable to our programs
• Ensure processes and documentation are in place and in compliance with State, Federal and NCQA requirements
• Provide support on regulatory audits and quality accreditation surveys, as needed
• Support our clinical leaders in disseminating feedback and conducting remediation
• Provide support on monitoring quality trends and identifying gaps to drive quality improvement activities
• Compliance with all applicable laws and regulations
• Other duties as assigned

Qualifications

• PharmD degree
• Active, unrestricted pharmacist license
• 4+ years of experience with UM reviews.
• 4+ years of experience with clinical research, policy development, and/or medical writing
• 3+ years of experience in Excel

Bonus Points

• Experience working with the CVS portal and criteria, or with MCG
• Experience working in a fast-paced, collaborative environment
• Residency training completed from an accredited ASHP or AMCP program

Travel

• 10% of the time

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