Manager, Risk Adjustment, Provider Partnerships

Hi, we're Oscar. We're hiring a Manager, Risk Adjustment, Provider Partnerships to join our Strategic Planning team.

Oscar is the first health insurance company built around a full stack technology platform and a relentless 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:

The Manager, Risk Adjustment (RA), Provider Partnerships leads the strategy and execution of Oscar's provider-facing risk adjustment initiatives. You will own cross-functional program delivery across Risk Adjustment, Network, Market, Data Science, and external provider partners; establishes the provider engagement and performance-management approach; and translates performance data into targeted improvement strategies.

You will represent Risk Adjustment priorities in contract, implementation, and operational planning discussions, manages risks and dependencies, and drives measurable improvement in documentation and coding outcomes.

You will report into the Director, Risk Adjustment Prospective and Planning.

Work Location:

This position is fully remote and open to candidates residing in the U.S., excluding

Alaska; Delaware; Hawaii; Louisiana; Montana; North Dakota; Oklahoma; West Virginia; Wyoming; and U.S. Territories. Daily work is completed from your home office, with occasional travel required for team meetings and company events. #LI-Remote

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.

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.
• Bonus points: 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.
• At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.

Artificial Intelligence (AI):

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Reasonable Accommodation:

Oscar applicants are considered solely based on their qualifications, without regard to applicant’s disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known.

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