About the company
This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Lead Product Manager - Interoperability Prior Authorization based in the United States.
Responsibilities
- Define and execute the product vision, strategy, and roadmap for medical prior authorization and electronic prior authorization (ePA) capabilities.
- Partner with clinical, business, operational, technology, compliance, provider, and utilization management stakeholders to identify opportunities and improve authorization workflows and customer experiences.
- Translate complex clinical, operational, business, and regulatory requirements into clear product solutions, business requirements, user journeys, implementation plans, and measurable success criteria.
- Lead complex cross-functional initiatives from discovery through delivery, collaborating closely with Product Owners, Engineering, and delivery teams to ensure successful execution.
- Drive simplification, automation, and operational efficiency across prior authorization processes while reducing administrative burden for providers and members.
- Build and maintain strategic relationships with EHR/EMR vendors, interoperability partners, industry organizations, clearinghouses, and other external stakeholders.
- Monitor CMS regulations, interoperability requirements, healthcare technology trends, and industry developments to ensure product strategies remain compliant and forward-looking.
- Establish, monitor, and communicate product performance metrics covering provider experience, adoption, operational efficiency, compliance, and business outcomes.
- Present product strategy, roadmap priorities, risks, progress, and value realization to senior and executive leadership.
- Identify opportunities for continuous improvement, organizational change, and technology adoption that enhance transparency and streamline healthcare authorization experiences.
Requirements
- Bachelor's degree or equivalent practical experience.
- 8+ years of experience in Product Management, Healthcare Technology, Clinical Operations, Utilization Management, or a related field.
- Demonstrated expertise with medical prior authorization and/or electronic prior authorization workflows.
- Strong understanding of healthcare payer operations, utilization management, clinical review processes, and provider workflows.
- Experience interpreting and implementing CMS regulations, healthcare interoperability requirements, and regulatory-driven product capabilities.
- Proven ability to develop product strategies, visions, and roadmaps while delivering measurable business outcomes.
- Experience leading complex cross-functional programs involving clinical, operational, technology, compliance, and business stakeholders.
- Strong requirements-gathering and prioritization skills, with the ability to translate business and regulatory needs into actionable product solutions.
- Excellent stakeholder management, communication, presentation, and influencing skills, particularly within highly matrixed organizations.
- Strong analytical, problem-solving, and decision-making capabilities, with the ability to manage competing priorities in complex environments.
- Experience with prior authorization modernization, automation, digital transformation, or similar healthcare technology initiatives is preferred.
- Familiarity with healthcare interoperability standards and technologies such as FHIR, APIs, HL7, and related healthcare data-exchange frameworks is preferred.
- Experience supporting CMS interoperability initiatives and regulatory mandates is a plus.
- Experience with provider-facing healthcare technology, EHR/EMR integrations, clearinghouses, or interoperability vendors is preferred.
- Experience driving organizational change and adoption of new healthcare technology solutions is advantageous.
- An MBA, MHA, RN, PharmD, or another relevant advanced degree is a plus.
Conditions
- Annual base salary range of $126,300–$173,700, depending on geographic location, experience, education, certifications, and other job-related factors.
- Eligibility for a bonus incentive plan based on company and/or individual performance.
- Comprehensive medical, dental, and vision coverage.
- 401(k) retirement savings plan.
- Paid time off, company holidays, and personal holidays.
- Paid parental and caregiver leave.
- Short-term and long-term disability coverage.
- Life insurance and additional employee benefits supporting whole-person wellbeing.
- Fully remote work opportunity available nationwide within the United States.
- 40-hour standard workweek.
- Occasional travel to company offices may be required for training, meetings, or other business needs.
- Remote employees must maintain reliable internet access, with at least 25 Mbps download and 10 Mbps upload speeds recommended.
- Dedicated, interruption-free workspace.