Manager, Formulary Operations

Hi, we're Oscar. We're hiring a Manager, Formulary Operations to join our team.

Oscar is the first health insurance company built around a full stack technology platform and a focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.

About the role

You will oversee internally formulary management operations and ensuring that appropriate oversight is in place where formulary management is delegated to a third-party. You will partners with the Sr. Manager to monitor the existing formulary operations and strategize future changes. You will also partners with internal stakeholders to execute on run tasks for maintenance of business operations of the existing formulary.

You will report to the Sr. Manage, Formulary Operations.

Work Location:

Oscar is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture and our mission.

If you live within commutable distance to our New York City office (in Hudson Square), our Tempe office (off the 101 at University Dr), or our Los Angeles office (in Marina Del Rey), you will be expected to come into the office at least two days each week. Otherwise, this is a remote / work-from-home role.

You must reside in one of the following states: Alabama, Arizona, Arkansas, California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, Virginia, Washington, or Washington, D.C. Note, this list of states is subject to change. #LI-Remote

Pay Transparency:

The base pay for this role is: $144,000 - $189,000 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.

Responsibilities

• This role is accountable for: ensuring clinical quality standards are met by maintaining clinical policies used for decision-making; ensure that compliance standards set by regulators and NCQA are defined in policies, that procedures are documented, and that those processes audited. 

• Operationalize, develop and maintain a clinically appropriate and cost-effective formulary and medical benefit preferred drug list  by operating and managing Oscar’s P&T committee, which includes evaluating new developments in the drug treatment landscape and providing recommendations on how to manage new to market drugs and new drug indications.   
• Provide written recommendations with responses and corresponding documentation for regulatory inquiries, feedback on future legislation, and other business questions that probe at formulary operations. 
• Responsible for annual formulary binder filings

• Accountable and responsible for maintaining mental health parity NQTL responses and working cross-functionally for future filings and responding to ongoing objections during the audit process. 
• Compliance with all applicable laws and regulations
• Other duties as assigned

Qualifications

• Doctor of Pharmacy degree (PharmD)
• 3+ years working for PBM or Payer in clinical pharmacy operations
• 3+ years leading cross-functional teams/projects and change management
• 3+ years supporting formulary management (P&T Committee, clinical policy development, formulary run operations)

Bonus Points

• Residency Training
• Experience with Marketplace Exchange