Senior Manager, Clinical & Disease Specific Insurance Solutions

About the role:The Senior Manager, Clinical & Disease Specific Insurance Solutions, owns the end to end lifecycle of insurance products designed to serve members with specific clinical needs or disease profiles (e.g., diabetes, COPD). This role is accountable for product strategy, benefit design, launch, performance management, and ongoing optimization, ensuring plans improve access, remove barriers to care, improve clinical outcomes, and affordability, while remaining compliant and operationally scalable.You will report into the Vice President, Insurance Product Innovation and Development.Work Location:This is a remote / work-from-home role. You must reside in one of the following states: Arizona, California, Colorado, Florida, Georgia, Illinois, Massachusetts, Michigan, Nevada, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Texas, or Virginia. Note, this list of states is subject to change.Pay Transparency:The base pay for this role is: $149,040 - $195,615 per year in New Jersey, New York, and California. The base pay for all other locations is: $134,136 - $176,053 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program, and annual performance bonuses.Responsibilities:Clinical & Disease Specific Plan Strategy & Design Own the full end to end lifecycle of clinical and disease specific insurance products from ideation/strategy and benefit design through launch, performance management, and optimization aligned to outcomes, regulatory requirements, affordability and growth objectivesBuild and manage business cases for new and existing products, including financial modeling, membership projections, and ongoing performance tracking against goalsAnalyze product performance using financial and membership metrics to forecast results, identify risks and opportunities, and inform decision-makingLead benefit design for disease-specific plans, including augmenting existing offerings, remediating underperforming designs, and introducing new benefit structures informed by clinical insight, utilization patterns, and product performanceDesign and manage product portfolios aligned to defined clinical populations, such as members with chronic conditions, high cost, or high utilization profiles, or condition specific care needsContribute to annual planning, roadmap development, and prioritization for clinical and disease-specific productsIdentify risks, gaps, and opportunities across benefit design, performance, affordability, and access, recommending corrective actions as neededExecution, Filings and Regulatory Alignment Responsible for execution of clinical plan designs through internal approvals, filings and supporting documentationPartner with regulatory and legal teams and incorporate federal and state regulatory guidance, clinical mandates and medical policy changes into plan designs and pricing inputsEnsure compliance with all applicable laws, regulations, and internal governance standardsCross Functional Leadership & Collaboration Serve as the primary product directly responsible individual (DRI) for clinical plans, coordinating all necessary plan aspects across Clinical, Actuarial, Network, Medical Affairs, Finance, Legal and CompliancePerformance & Optimization Develop and maintain regular performance reporting and product look-backs, assessing financial, clinical, operational, and outcomes across disease-specific populationsLead cross-functional execution for clinical product enhancements, pilots, and issue resolutionCompliance with all applicable laws and regulationsOther duties as assignedRequirements:6+ years of experience developing, managing, or supporting commercial insurance products, including clinical programs and disease-specific product offerings5+ years of experience and Understanding of clinical policy, utilization management, quality programs and regulatory requirements (ACA, state mandates, CMS guidance, etc…)3+ years multi-year experience with ACA, including individual market place and small group products3+ years demonstrated ownership of end to end product lifecycle management3+ years experience and proven ability to lead cross-functionally in highly regulated, matrixed and sometimes vague environments3+ years experience making Strong analytical and data-driven decisions with Ability to translate population-specific insights into product and benefit design decisionsTravel up to 25% of the timeBonus points:Bachelor's degree in business, healthcare, public policy, analytics, or related fieldExperience developing or managing clinically differentiated health plans.Familiarity with medical policy development, clinical governance and provider models.Experience supporting regulatory filings and auditsExperience developing or managing products for chronic conditions, high-utilizer populations, or disease-specific cohortsExperience with business intelligence tools, experience with SQL, Excel, or similar toolsExperience incorporating clinical outcomes, quality measures, and care management programs into product designBackground in population health, value-based care, or care delivery innovation a plusAt Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care– an experience made whole by our unique backgrounds and perspectives.Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (View email address on click.appcast.io) to make the need for an accommodation known.California Residents: For information about our collection, use, and disclosure of applicants' personal information as well as applicants' rights over their personal information, please see our Privacy Policy.J-18808-Ljbffr