Senior Manager, Network Performance

Oscar Health•Hartford, CT

2d•$163,944 - $215,176•Remote

About The Position

The Senior Manager, Medical Economics, leads a team of analysts to drive actions to support Oscar's total cost of care (TCoC) strategy and efforts. The Senior Manager collaborates closely with analytical leads across forecasting, medical cost analytics, pricing, network analytics, and data science units to identify medical expense saving opportunities and to develop sound projections and measurements of the medical cost effects and clinical outcomes of initiatives, with an ultimate goal of improving total cost of care and driving affordability value. You will report into the VP, Medical Economics.

Requirements

Bachelor's degree in a STEM field.
7+ years of relevant quantitative analysis experience.
Proven experience in health insurance / payer analytics, with an understanding of medical claims data (e.g., CPT/HCPCS, ICD-10, DRGs) and standard healthcare industry data sources.

Nice To Haves

Associate or Fellow of the Society of Actuaries (SOA), or on the track to become one.
Experience developing measurement of clinical intervention ROI.
Knowledge of prior authorization optimization and automation.
Familiarity with pharmacy economics.
Background in value-based care analytics.
Experience translating between clinical, business, and analytic vocabularies.

Responsibilities

Lead team programs to identify and measure cost-saving initiatives.
Provide mentorship, and development planning for team members to promote growth and learning.
Maintain current knowledge of medical economics best practices, and work to drive innovation and new approaches.
Develop proactive financial models to assess the potential cost and use impacts of proposed clinical programs, network strategies, and policy changes. Conduct sensitivity analyses and stress-testing on models to understand the range of potential outcomes under multiple utilization and cost scenarios.
Perform in-depth analysis of integrated claims and operational data — e.g. medical, pharmacy, labs and authorizations) to identify cost and trend drivers.
Design and build retrospective studies to measure the actual financial and clinical outcomes of implemented programs, comparing results against initial projections.
Promote and shape best practices concerning documentation.
Contribute departmental improvements in automation, AI application, and analytic tooling to increase efficiency and the sophistication of your team's work.
Serve a trusted analytic business partner and advisor to stakeholders in supported functional units.
Maintain relationships, rapport, and lines of communication with stakeholders.
Influence and collaborate with partners to guide strategic business decisions with respect to medical expense initiatives.
Compliance with all applicable laws and regulations
Other duties as assigned