Hi, we're Oscar. We're hiring an Associate, Pharmacy Policy Development 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
The Associate helps Oscar develop and review our policies given the fast pace of changes in medical literature and standards. You will play an essential part in ensuring our members receive high quality care. You will take the lead in drafting, obtaining approval, and maintaining pharmaceutical and medical drug policies based on current clinical evidence and nationally-recognized standards.
You will report to the Manager, Pharmacy 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: $98,400 - $129,150 per year. You are also eligible for employee benefits, participation in Oscar’s unlimited vacation program, and annual performance bonuses.
Responsibilities
- Review, develop, and amend our policies referencing standards of care, third party criteria, and other sources to ensure they support the most up to date standards, working in close partnership with our Pharmacy Operations team.
- Track edits, amendments, evidence submissions and feedback in accordance with Clinical Policy operational 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
- Compliance with all applicable laws and regulations
- Other duties as assigned
Qualifications
- PharmD degree
- Active, unrestricted pharmacist license
- 3+ years of experience with clinical research, policy development, and/or medical writing
- 3+ years of experience reviewing prior authorizations
- 3+ years of experience communicating, both written and verbally, across all levels of stakeholder
- 3+ years of experience using Excel
Bonus Points
- Experience working with the CVS portal and criteria, or with MCG
- Experience working in a fast-paced, collaborative environment
- Medical coding experience and/or certification
- Regulatory or compliance experience
- Experience working in a fast-paced, collaborative environment
- Residency training completed from an accredited ASHP or AMCP program
