Oscar Health - Manager, Risk Adjustment, Provider Partnerships
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. • Risk adjustment experience in a health plan, provider organization, health system, or consulting environment. • Experience with provider contracting, value-based care, provider performance programs, or provider engagement models. • SQL/BigQuery or comparable analytical-tool experience. • Lean/Six Sigma, or similar process improvement experience. • This is an authentic Oscar Health job opportunity.
Responsibilities
• 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. • Compliance with all applicable laws and regulations. • Other duties as assigned.
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