Oscar Health · 11 hours ago
UM Program Operations Manager
Phoenix, AZ
Full-time
Hybrid
Mid, Senior Level
$106K/yr - $139K/yr
4+ years expOscar Health is a health insurance company focused on serving its members through a technology-driven platform. They are seeking a UM Program Operations Manager to oversee the execution of key programs, ensuring operational soundness and compliance as the company expands.
Health CareHealth InsuranceInsuranceInsurTech
Responsibilities
Lead the end-to-end execution and refresh cycles for "Gold Card" and "Provider Incentive" programs. This includes managing provider entry/exit criteria, coordinating the clinical audit framework, and ensuring accurate provider status updates
Act as the primary owner of the "Source of Truth" for the Prior Authorization list. You will lead the cross-functional governance process to ensure code additions, removals, and modifications are clinically adherent and accurately reflected across all internal systems and public-facing documents
Ensure all UM programs meet state and federal mandates, including emerging "Gold Card" legislation and transparency requirements. You will be the team's point of contact for Legal and Compliance audits
Develop and maintain the Standard Operating Procedures (SOPs) for net-new initiatives. You ensure that as the team innovates, the operational "blueprints" exist to make those innovations repeatable
Drive the recurring refresh cycles for auto-approval rules and provider incentive programs, ensuring they remain current with shifting clinical guidelines and medical policies
Lead the end-to-end management of cross-functional implementations/projects, including project plan creation, stakeholder engagement, managing cross-functional relationships to drive collaboration, edge case mitigation, and on-time completion
Evaluate overall departmental performance by creating, gathering, analyzing and interpreting data and metrics as well as assisting in development of departmental metrics and implementation of mitigation strategies
Collaboratively works with all relevant internal and external stakeholder groups to formulate proactive implementation, communications, and program strategies for successful change management and risk mitigation initiatives
May oversee team members directly as well as mentors team members and promotes colleagues' growth and professional development
Compliance with all applicable laws and regulations
Other duties as assigned
Qualification
Required
4+ years of experience in program management
3+ years of experience in delivering projects / programs
2+ years of experience in managing prior authorization list process (updates, coordination)
Experience in payer/health insurance
Preferred
Experience using data and metrics to drive improvements in programs
Experience / background in a fast-paced operations environment
Experience managing Gold Card programs and updates
Experience managing the Prior Authorization List process
Successfully executed enterprise-wide initiatives: defined project plans, coordinated resources, managed implementation activities, and developed all processes associated with program rollout and ongoing support
Master's Degree
PMP Certifications or Program Management Certifications
Lean/Six Sigma Certifications
Healthcare experience (Health Insurance, Health Systems, or Healthcare Consulting)
Benefits
Employee benefits
Participation in Oscar's unlimited vacation program
Annual performance bonuses
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
H1B Sponsorship
Oscar Health has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (19)
2024 (24)
2023 (22)
2022 (36)
2021 (13)
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