Senior Manager, Clinical & Disease Specific Insurance Solutions

📋 Description

• • As the Senior Manager, Clinical & Disease Specific Insurance Solutions at Oscar Health, you will be the pivotal force driving the strategy, design, and lifecycle management of insurance products tailored for members with specific clinical needs or chronic conditions. This is a unique opportunity to shape the future of healthcare by developing innovative solutions that directly impact patient outcomes, improve access to care, and enhance affordability.
• • You will own the end-to-end journey of these specialized insurance plans, from initial ideation and strategic planning through meticulous benefit design, successful launch, ongoing performance monitoring, and continuous optimization. Your work will be instrumental in ensuring these plans not only meet but exceed member needs, while remaining compliant with all regulatory requirements and operationally scalable.
• • A core aspect of your role will involve building and managing robust business cases for new and existing products. This includes conducting thorough financial modeling, projecting membership growth, and establishing key performance indicators (KPIs) to track progress against strategic objectives. You will leverage these insights to forecast results, identify potential risks and opportunities, and inform critical decision-making processes.
• • You will lead the benefit design for disease-specific plans, which may involve augmenting current offerings, redesigning underperforming benefit structures, or introducing entirely new benefit frameworks. These designs will be informed by deep clinical insights, analysis of utilization patterns, and a keen understanding of product performance data, ensuring maximum value and effectiveness for members.
• • Your strategic vision will extend to designing and managing product portfolios that are precisely aligned with defined clinical populations. This includes members managing chronic conditions, those with high healthcare utilization, or individuals requiring specialized care for specific diseases. The goal is to create a comprehensive suite of products that addresses diverse and complex member needs.
• • You will play a key role in Oscar's annual planning cycles, contributing significantly to roadmap development and prioritization for clinical and disease-specific products. This involves identifying strategic priorities and ensuring alignment with the company's overall growth and innovation objectives.
• • Proactively identify and address risks, gaps, and opportunities across benefit design, product performance, affordability, and access to care. You will be responsible for recommending and implementing corrective actions to ensure the continued success and member-centricity of the product suite.
• • You will be responsible for the seamless execution of clinical plan designs, navigating internal approval processes, managing regulatory filings, and ensuring all supporting documentation is accurate and complete. This requires meticulous attention to detail and a deep understanding of the healthcare regulatory landscape.
• • Collaborate closely with regulatory and legal teams to ensure all plan designs and pricing inputs are in strict accordance with federal and state regulations, clinical mandates, and evolving medical policy changes. Maintaining compliance with all applicable laws, regulations, and internal governance standards is paramount.
• • Serve as the primary point of contact and the Directly Responsible Individual (DRI) for all clinical plans. You will orchestrate and coordinate all necessary plan aspects across a diverse range of internal departments, including Clinical, Actuarial, Network, Medical Affairs, Finance, Legal, and Compliance, fostering strong cross-functional partnerships.
• • Develop and maintain comprehensive performance reporting and product look-back analyses. This involves assessing financial, clinical, operational, and overall outcomes across various disease-specific populations to drive continuous improvement and strategic adjustments.
• • Lead cross-functional execution for critical initiatives such as clinical product enhancements, pilot programs, and complex issue resolution, ensuring timely and effective implementation.
• • Ensure strict adherence to all applicable laws and regulations throughout the product lifecycle.
• • Undertake other duties as assigned, demonstrating flexibility and a commitment to the team's success.