Oscar Health · 1 month ago
Manager, Medical Policy
New York, New York, United States
Full-time
Hybrid
Mid, Senior Level
$131K/yr - $172K/yr
5+ years expOscar is a health insurance company built around a full stack technology platform, seeking a Manager, Medical Policy to lead the development of evidence-based medical necessity criteria. The role involves overseeing the clinical lifecycle of medical policies and ensuring compliance with clinical standards to support optimal health outcomes for members.
Health CareHealth InsuranceInsuranceInsurTech
Responsibilities
Lead the review of clinical literature, regulating agency guidance (e.g., FDA, CMS, State/Federal Departments), and specialty society guidelines to develop sound coverage criteria for medical services, devices and technologies
Conduct and manage health technology assessments for novel medical technologies and complex devices
Coordinate with internal and external specialty-matching physicians for the clinical review and validation of medical policies
Translate complex clinical data and evidence-based recommendations into precise, defensible medical necessity criteria and clinical positions or guidance
Own the end-to-end drafting and maintenance of the medical policy library, ensuring language is clinically accurate, unambiguous, and operationally interpretable
Responsible for the preparation and presentation of evidence-based medical policies and summaries of changes to the Clinical Advisory Subcommittee (CAS) and internal forums
Oversee, onboard, develop, and manage a team of clinical FTEs, contractors, and matrixed reports
Ensure all clinical policy development processes are streamlined and align with the larger departmental and Office of Clinical Affairs (OCA) strategy
Ensure clinical policy development processes and documentation comply 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
Qualification
Required
Graduate degree in Healthcare Administration, Public Health, Health Policy, Health Services Research, Epidemiology, or a closely related discipline (such as Nursing or another allied health field)
5–8 years in healthcare, with 3–5 years specifically focused on medical policy development, clinical research, or medical writing
Experience in people leadership, including the ability to manage, mentor, and develop clinical professionals
Proficiency in leveraging clinical databases (e.g., PubMed) to conduct literature reviews, evaluate evidence, and synthesize findings into defensible medical necessity criteria or recommendations
Expert ability to interpret complex clinical data and conduct health technology assessments to determine medical coverage standards
Preferred
Active, unrestricted clinical license (e.g., RN, NP, PA)
Working knowledge of medical coding (e.g. CPT, ICD-10, HCPCS) and claims
2+ years of experience using Excel/Google Sheets and PowerPoint/Google Slides
Ability to translate technical clinical evidence for both clinical and non-clinical stakeholders
Experience with Managed Care regulatory requirements, NCQA standards, and ACA marketplace rules
Background in managed care, utilization management, or evidence-based clinical guideline development
Experience in fast-paced, tech-enabled environments with complex cross-functional stakeholder management
Benefits
Medical, dental, and vision benefits
11 paid holidays
Paid sick time
Paid parental leave
401(k) plan participation
Life and disability insurance
Paid wellness time and reimbursements
Company
Oscar Health
Oscar is a health insurance company that offers individual and family plans, medicare advantages, and small group products.
1001-5000 employees
Funding
Current Stage
Public CompanyTotal Funding
$1.99BKey Investors
Tiger Global ManagementAlphabetFounders Fund
2025-09-16Post Ipo Debt· $355M
2021-03-03IPO
2020-12-17Private Equity· $140M
Leadership Team
Mark Bertolini
Chief Executive Officer
Steven B. Kelmar
Executive Vice President & COS
Recent News
2026-01-17
2026-01-16
2026-01-16
Company data provided by crunchbase