Lead Product Manager - Interoperability Prior Authorizations

Accountabilities:

• • 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.

  Benefits:

  • 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 required to protect confidential healthcare and HIPAA-related information.