UM Program Operations Manager

Oscar Health•New York, NY

1d•$117,576 - $154,318•Hybrid

About The Position

The Manager of UM Program Operations is the "Execution Engine" of the UM Strategy team. While our strategists identify what we should do, you own the how. You are responsible for the flawless execution of high-impact programs like Gold Carding, Provider Incentive Programs, and the maintenance of our Prior Authorization (PA) List. You will ensure that every program is operationally sound, regulatory compliant, and scales effectively as our footprint expands. You will report into the Director, UM Authorization Strategy.

Requirements

4+ years of experience in program management
3+ years of experience in delivering projects / programs
2+ years of experience in managing prior authorization list process (updates, coordination)
Experience in payer/health insurance

Nice To Haves

Experience using data and metrics to drive improvements in programs
Experience / background in a fast-paced operations environment
Experience managing Gold Card programs and updates
Experience managing the Prior Authorization List process
Successfully executed enterprise-wide initiatives: defined project plans, coordinated resources, managed implementation activities, and developed all processes associated with program rollout and ongoing support
Master’s Degree
PMP Certifications or Program Management Certifications
Lean/Six Sigma Certifications
Healthcare experience (Health Insurance, Health Systems, or Healthcare Consulting)

Responsibilities

Lead the end-to-end execution and refresh cycles for "Gold Card" and "Provider Incentive" programs. This includes managing provider entry/exit criteria, coordinating the clinical audit framework, and ensuring accurate provider status updates.
Act as the primary owner of the "Source of Truth" for the Prior Authorization list. You will lead the cross-functional governance process to ensure code additions, removals, and modifications are clinically adherent and accurately reflected across all internal systems and public-facing documents.
Ensure all UM programs meet state and federal mandates, including emerging "Gold Card" legislation and transparency requirements. You will be the team's point of contact for Legal and Compliance audits.
Develop and maintain the Standard Operating Procedures (SOPs) for net-new initiatives. You ensure that as the team innovates, the operational "blueprints" exist to make those innovations repeatable.
Drive the recurring refresh cycles for auto-approval rules and provider incentive programs, ensuring they remain current with shifting clinical guidelines and medical policies.
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 formulate proactive implementation, communications, and program strategies for successful change management and risk mitigation initiatives
May oversee team members directly as well as mentors team members and promotes colleagues' growth and professional development
Compliance with all applicable laws and regulations
Other duties as assigned