Program Associate Pharmacy (Remote)

Hi, we're Oscar. We’re hiring a Program Associate to join our Pharmacy Department. 

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 ourselves—one that behaves like a doctor in the family.

About the role:

The Program Associate is responsible for driving execution with Oscar teams (e.g. network, data science, product, population health) and being one of the primary points of coordination with our pharmacy benefits manager. The role combines leadership in project execution with ongoing operational process improvement, partner relationship management and capability building. 

You will report into the Director of Pharmacy Programs and Implementation . This is a remote role, you are able to work remotely in one of the following states: Arizona, California, Connecticut, Florida, Georgia, Illinois, Maryland, Massachusetts, Michigan, New Jersey, New Mexico, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, Tennessee, Texas, Utah, Virginia, or Washington. Note, this list of states is subject to change.

Responsibilities:

Implement pharmacy benefits across a line of business: This includes planning, configuration, testing, and monitoring of all elements of pharmacy plan design, formulary configuration, and special requirements. Leading annual implementation, ongoing monitoring, and pharmacy benefit manager (PBM) oversight for the market.

Manage and contribute to projects that improve or expand the pharmacy offering. Responsibilities include developing, testing and implementing a pharmacy claims oversight program that reviews rejected claims, contract adherence, savings opportunities, and program efficiencies.

Oversee Compliance and Regulatory for the IFP line of business Support policy process and ensure that we have policies and procedures for state regulations and perform annual review for changes and submission to Legal for updating. Tasks include assisting with audit(s), working with complaints and grievances (C&G) and other stakeholders to address themes in member complaints and coordinating quarterly reporting (SLA) from our PBM

Support business alignment and oversight with key stakeholders: Providing cross-program (Medicare, +O) support to other pharmacy program managers. Examples of cross-department activities include supporting improved virtual prescribing and minimizing Fraud, Waste, and Abuse (FWA).

Requirements:

Bachelor's degree or 4 years commensurate experience

3+ years working for PBM, Payer or Pharmacy Consulting firm, reviewing healthcare data

3+ years leading cross-functional teams/projects and change management

1+ years working with health insurance regulation/compliance

Bonus points:

Experience with pharmacy claim testing and Quality Assurance (QA)

Experience with ticketing system (such as Jira)

Experience with payers offering ACA/health exchange insurance 

Experience with payers offering Medicare insurance

Life at Oscar: 

At 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.

We aim to make health care affordable and accessible for all, and apply this same vision to our perks and benefits, including: medical benefits, generous paid-time off, paid parental leave, retirement plans, company social events, stocked kitchens, wellness programs, and volunteer opportunities.