Senior Manager, Clinical & Disease Specific Insurance Solutions

Oscar Health•New York City, NY

2d•Remote

About The Position

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.

Requirements

6+ years of experience developing, managing, or supporting commercial insurance products, including clinical programs and disease-specific product offerings
5+ 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 products
3+ years demonstrated ownership of end to end product lifecycle management
3+ years experience and proven ability to lead cross-functionally in highly regulated, matrixed and sometimes vague environments
3+ years experience making Strong analytical and data-driven decisions with Ability to translate population-specific insights into product and benefit design decisions
Travel up to 25% of the time

Nice To Haves

Bachelor’s degree in business, healthcare, public policy, analytics, or related field
Experience developing or managing clinically differentiated health plans.
Familiarity with medical policy development, clinical governance and provider models.
Experience supporting regulatory filings and audits
Experience developing or managing products for chronic conditions, high-utilizer populations, or disease-specific cohorts
Experience with business intelligence tools, experience with SQL, Excel, or similar tools
Experience incorporating clinical outcomes, quality measures, and care management programs into product design
Background in population health, value-based care, or care delivery innovation a plus

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 objectives
Build and manage business cases for new and existing products, including financial modeling, membership projections, and ongoing performance tracking against goals
Analyze product performance using financial and membership metrics to forecast results, identify risks and opportunities, and inform decision-making
Lead 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 performance
Design 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 needs
Contribute to annual planning, roadmap development, and prioritization for clinical and disease-specific products
Identify risks, gaps, and opportunities across benefit design, performance, affordability, and access, recommending corrective actions as needed
Execution, Filings and Regulatory Alignment Responsible for execution of clinical plan designs through internal approvals, filings and supporting documentation
Partner with regulatory and legal teams and incorporate federal and state regulatory guidance, clinical mandates and medical policy changes into plan designs and pricing inputs. Ensure compliance with all applicable laws, regulations, and internal governance standards
Cross 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 Compliance
Performance & Optimization Develop and maintain regular performance reporting and product look-backs, assessing financial, clinical, operational, and outcomes across disease-specific populations
Lead cross-functional execution for clinical product enhancements, pilots, and issue resolution
Compliance with all applicable laws and regulations
Other duties as assigned