Senior Manager, Medical Economics

Hi were Oscar. Were hiring a Senior Manager Medical Economics to join our Medical Economics.

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 ourselvesone that behaves like a doctor in the family.

About the role:

The Senior Manager Medical Economics leads a team of analysts to guide next steps to support Oscars total cost of care (TCoC) strategy and efforts.

The Senior Manager collaborates with analytical leads across forecasting medical economics pricing network analytics and data science units to identify medical expense saving opportunities and to develop sound projections and measurements of the medical cost effects and clinical outcomes of programs with an ultimate goal of improving total cost of care and driving affordability value. You will partner with Oscars Office of Clinical Affairs and data science team to ensure accurate projections of clinical policy initiatives are reflected in management reporting e.g. financial close forecasts program performance monitoring.

You will report into the Senior Director Medical Cost Analytics.

Work Location:

This is a remote position open to candidates who reside in: Atlanta GA. 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:$142560 - $187110 per year. You are also eligible for employee benefits participation in Oscars unlimited vacation program and annual performance bonuses.

Responsibilities:

• Lead team programs to identify and measure cost-saving programs.
• Provide mentorship and development planning for team members to promote growth and learning.
• Maintain current knowledge of medical economics best practices and drive innovation and new approaches.
• Develop proactive financial models to assess the potential cost and use impacts of proposed clinical programs network strategies and policy changes. Conduct sensitivity analyses and stress-testing on models to understand the range of potential outcomes under multiple utilization and cost scenarios.
• Perform in-depth analysis of integrated claims and operational data e.g. medical pharmacy labs authorizations) to identify cost and trend drivers.
• Design and build retrospective studies to measure the actual financial and clinical outcomes of implemented programs comparing results against initial projections.
• Promote and shape best practices with respect to documentation.
• Contribute departmental improvements in automation AI application and analytic tooling to increase efficiency and the sophistication of your teams work.
• Serve a trusted analytic partner and advisor to team members in supported functional units.
• Maintain relationships and lines of communication with stakeholders.
• Influence and collaborate with stakeholders to guide strategic business decisions with respect to medical expense initiatives.
• Compliance with all applicable laws and regulations
• Other duties as assigned

Requirements:

• Bachelors degree in a STEM field.
• 7 years of relevant quantitative analysis experience.
• Proven experience in health insurance / payer analytics with an understanding of medical claims data (e.g. CPT/HCPCS ICD-10 DRGs) and standard healthcare industry data sources.

Bonus points:

• Associate or Fellow of the Society of Actuaries (SOA) or on the track to become one.
• Significant experience analyzing and forecasting the financial impact of proposed changes to clinical policies policy sets utilization management processes and clinical pathways.
• Experience developing measurement of clinical intervention ROI.
• Knowledge of prior authorization optimization and automation.
• Familiarity with pharmacy economics.
• Background in value-based care analytics.
• Experience translating between clinical business and analytic vocabularies.