Pharmaceutical Policy Specialist
6 days ago
We're seeking a highly skilled Clinical Policy Developer to join our Clinical Policy team at Oscar Health. This individual will be responsible for reviewing, developing, and amending policies referencing standards of care, third-party criteria, and other sources to ensure they support the most up-to-date standards.
Responsibilities
- Review, develop, and amend policies referencing standards of care, third-party criteria, and other sources to ensure they support the most up-to-date standards.
- Track edits, amendments, evidence submissions, and feedback in accordance with Clinical Policy operational standards.
- Develop an in-depth understanding of regulatory and quality requirements applicable to our programs.
- Ensure processes and documentation are in place and in compliance with State, Federal, and NCQA requirements.
Required Skills and Qualifications
- PharmD degree
- Active, unrestricted pharmacist license
- 3+ years of experience with clinical research, policy development, and/or medical writing
- 3+ years of experience reviewing prior authorizations
- 3+ years of experience communicating, both written and verbally, across all levels of stakeholders
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