Associate, UM Regulatory Operations

Oscar Health•Dallas, TX

3d•Remote

About The Position

You will be responsible for working cross functionally with business and technical Oscar stakeholders and representing the needs and interests of the department in company wide strategic initiatives and in solving business problems related to internal processes. This requires collecting and documenting business requirements, building and managing project plans, documenting key project decisions, managing project governance, applying frameworks, analyzing data, and developing and communicating risk mitigation strategies across disparate initiatives and stakeholders at the same time. You will report into the Senior Manager, UM Regulatory Operations.

Requirements

A bachelor's degree or 3+ years commensurate experience
3+ years of work experience in healthcare Utilization Management operations, health insurance, and/or related field
2+ years of experience supporting regulatory compliance activities, including Mental Health Parity (MHPAEA), market conduct exams, license renewals, NCQA surveys/accreditation, and other regulatory filings
2+ years of experience with end to end project management or process improvement initiatives
2+ years of experience in regulatory implementation and compliance
2+ years of experience in designing and improving workflows as well as standing up accompanying operating and technical procedures

Nice To Haves

2+ years of experience using data software such as Excel, Microsoft Office, Google Sheets, GSuite
Experience collaborating with legal, compliance, and cross-functional teams
Experience with process improvement methodologies such as Lean, Six Sigma and/or Theory of constraints

Responsibilities

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 to interpret and apply new and evolving regulations, ensuring consistent understanding and accurate implementation across UM operations.
Coordinate regulatory request management for the UM department, including market conduct exams, URA filings, license renewals, and Mental Health Parity (MHPAEA) compliance.
Coordinates NCQA deliverables for UM standards
Evaluates and drafts UM policy and procedures ensuring compliance within the UM program
Mentor team members and promotes colleagues' growth and professional development
Compliance with all applicable laws and regulations
Other duties as assigned