Remote Associate

Summary

Join Oscar's Clinical Policy team as an Associate, Medical Policy Development and help develop and review medical policies.

Requirements

• Active, unrestricted RN (BSN preferred) license
• 3+ years of clinical research, policy development, medical writing, quality auditing, claims/payment integrity auditing, or utilization management review
• 3+ years of experiencing using Excel
• 3+ years of experience communicating, both written and verbally, with stakeholders at all levels
• 3+ years of experience solving complex problems

Responsibilities

• Track edits, amendments, evidence submissions and feedback in accordance with policy team's operational standards
• Develop an in-depth understanding of regulatory and quality requirements applicable to our programs
• Track evidence submissions and feedback on policies, and prioritize policy updates
• Ensue processes and documentation are in place and in compliance with State, Federal and NCQA requirements
• Provide support on regulatory audits and quality accreditation surveys, as needed
• Compliance with all applicable laws and regulations
• Other duties as assigned

Preferred Qualifications

• Medical coding experience and/or certification
• Experience with MCG criteria
• Regulatory or compliance experience
• Experience working in a fast-paced, collaborative environment

Benefits

• Medical benefits
• Dental benefits
• Vision benefits
• 11 paid holidays
• Paid sick time
• Paid parental leave
• 401(k) plan participation
• Life and disability insurance
• Paid wellness time and reimbursements