Lead Product Manager – Interoperability Prior Authorizations

This is a fully remote position, open to applicants in United States.

📋 Description

• Establish and implement the product vision, strategy, and roadmap for Prior Authorization and Electronic Prior Authorization functionalities.

• Collaborate with business, clinical, operational, and technology stakeholders to enhance authorization workflows and customer experiences.

• Transform clinical, operational, regulatory, and business requirements into product solutions and delivery plans.

• Lead cross-functional teams to define business requirements, user journeys, success metrics, and implementation strategies.

• Work alongside Product Owners, Engineering, and delivery teams to carry out product initiatives.

• Promote process simplification, automation, and operational efficiency with Utilization Management, Provider, and Operations teams.

• Develop relationships with EMR/EHR vendors, interoperability partners, industry organizations, and external stakeholders.

• Keep track of CMS regulations, interoperability requirements, and industry trends.

• Set and monitor product performance metrics.

• Articulate product strategy, roadmap priorities, risks, and value realization to senior leadership and executive stakeholders.

• Foster continuous improvement to boost transparency, lessen administrative burdens, and enhance authorization experiences.

• Occasionally travel to Humana offices for training or meetings.

⛳️ Requirements

• Bachelor's degree or equivalent experience.

• Over 8 years of experience in Product Management, Healthcare Technology, Clinical Operations, Utilization Management, or a related field.

• Proficiency in Medical Prior Authorization and/or Electronic Prior Authorization workflows.

• Comprehensive understanding of healthcare payer operations, utilization management processes, and clinical review workflows.

• Experience in interpreting and applying CMS regulations and healthcare interoperability requirements.

• Proven track record in developing product strategies, visions, and roadmaps with quantifiable business outcomes.

• Demonstrated experience in leading complex cross-functional initiatives involving clinical, operational, technology, compliance, and business stakeholders.

• Capability to gather, prioritize, and convert business and regulatory requirements into product solutions.

• Excellent stakeholder management, communication, and executive presentation skills.

• Ability to influence and achieve alignment across matrixed organizations.

• Strong analytical, problem-solving, and decision-making abilities.

• Capacity to manage multiple priorities and drive execution in complex environments.

• Preferred: experience with FHIR, APIs, HL7, healthcare data exchange frameworks, provider workflow integration, clearinghouses, interoperability vendors, and healthcare technology adoption.

• Preferred: MBA, MHA, RN, PharmD, or another relevant advanced degree.

• Minimum home internet speed of 25 Mbps download and 10 Mbps upload.

• A dedicated workspace free from ongoing interruptions to safeguard PHI/HIPAA information.

🏝️ Benefits

• Bonus incentive plan.

• Medical benefits.

• Dental benefits.

• Vision benefits.

• 401(k) retirement savings plan.

• Paid time off.

• Company holidays.

• Personal holidays.

• Paid parental leave.

• Paid caregiver leave.

• Short-term disability.

• Long-term disability.

• Life insurance.

• Personal wellness support.

• Healthcare decision support.

• Work-from-home arrangement.