Manager, Risk Adjustment, Provider Partnerships

🔥 13 hours ago

🇺🇸 United States – Remote

💵 $96.1k - $126.2k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

💰 Account Manager

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Oscar Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2012

⚕️ Healthcare Insurance

🏥 Healthcare

💰 $355M Post-IPO Debt - Oscar Health on 2025-09

Healthcare Insurance • Healthcare

Oscar Health is a technology-driven health insurance company that provides individual, family, and small-group health plans in multiple U. S. states. Oscar combines traditional insurance underwriting with digital-first services — a consumer-facing app, 24/7 virtual urgent care, prescription delivery (including $3 meds in many plans), and dedicated Care Teams — and also operates Oscar Primary Care in some markets. The company emphasizes accessible, affordable, high-quality care and uses AI to improve member experience and care delivery. Insurance policies are underwritten by Oscar's state insurance subsidiaries and the company offers both HMO and other plan types across its markets.

📋 Description

• Lead the end-to-end strategy, implementation, and ongoing management of the Risk Adjustment Provider Partnerships program, including program plans, milestones, operating rhythms, risks, and success metrics • Partner with Network, Market, Legal/Contracting, Risk Adjustment, and Data Science teams to incorporate risk-adjustment requirements and enablement approaches into provider agreements and operating models • Establish and maintain operational relationships with provider organizations; drive alignment on performance expectations, improvement opportunities, and mutual commitments • Analyze provider performance, workflows, and documentation/coding trends to identify causes, prioritize opportunities, and develop targeted mitigation and improvement plans • Lead cross-functional implementation of provider-specific interventions; manage dependencies, resolve issues, and escalate decisions or risks that threaten outcomes or timelines • Develop and communicate performance reporting, program insights, risks, and recommendations to internal leaders and external partners • Build scalable provider education, engagement, and incentive approaches that improve adoption of risk-adjustment best practices • Ensure compliance with all applicable laws and regulations • Perform other duties as assigned • Report to the Director, Risk Adjustment Prospective and Planning

🎯 Requirements

• 4+ years of relevant experience in program management, strategic planning, provider partnerships, health-plan operations, risk adjustment, contracting, or a related field • Demonstrated experience leading complex, cross-functional programs from planning through implementation and ongoing performance management • Experience using quantitative and qualitative data to identify opportunities, recommend actions, and communicate conclusions to varied stakeholder audiences • Strong stakeholder-management, communication, and problem-solving skills, including experience navigating external partner relationships • Compliance with all applicable laws and regulations • SQL/BigQuery or comparable analytical-tool experience (bonus) • Risk adjustment experience in a health plan, provider organization, health system, or consulting environment (bonus) • Experience with provider contracting, value-based care, provider performance programs, or provider engagement models (bonus) • Lean/Six Sigma, or similar process improvement experience (bonus)

🏖️ Benefits

• Employee benefits • Unlimited vacation program • Annual performance bonuses • Sales commissions • Medical benefits • Dental benefits • Vision benefits • 11 paid holidays • Paid sick time • Paid parental leave • 401(k) plan participation • Life insurance • Disability insurance • Paid wellness time and reimbursements • Fully remote work from a home office • Occasional travel for team meetings and company events