Lead Product Manager - Interoperability Prior Authorizations

About the Role

Humana is seeking a Lead Product Manager - Interoperability Prior Authorization to drive the strategy, roadmap, and execution of products that modernize medical and electronic prior authorization experiences. This role will lead initiatives that improve provider and member experiences, streamline healthcare operations, and support compliance with evolving interoperability and regulatory requirements. The ideal candidate brings a strong understanding of healthcare payer operations, prior authorization workflows, clinical processes, and CMS regulations, combined with proven experience developing product strategies and leading complex cross-functional initiatives. This individual will play a key role in advancing Humana's vision for efficient, scalable, and interoperable prior authorization solutions.

Responsibilities

• Define and execute the product vision, strategy, and roadmap for Prior Authorization and Electronic Prior Authorization capabilities.
• Partner with business, clinical, operational, and technology stakeholders to identify opportunities to improve authorization workflows and customer experiences.
• Translate complex clinical, operational, regulatory, and business requirements into product solutions and delivery plans.
• Lead cross-functional efforts to define business requirements, user journeys, success metrics, and implementation strategies.
• Collaborate with Product Owners, Engineering, and delivery teams to ensure successful execution of product initiatives.
• Partner with Utilization Management, Provider, and Operations teams to drive process simplification, automation, and operational efficiency.
• Build and maintain relationships with EMR/EHR vendors, interoperability partners, industry organizations, and external stakeholders.
• Monitor CMS regulations, interoperability requirements, and industry trends to ensure product strategies remain compliant and forward-looking.
• Establish and track product performance metrics related to provider experience, operational efficiency, adoption, compliance, and business outcomes.
• Communicate product strategy, roadmap priorities, risks, and value realization to senior leadership and executive stakeholders.
• Drive continuous improvement initiatives that enhance transparency, reduce administrative burden, and improve authorization experiences for providers and members.

Requirements

• Bachelor's degree or equivalent experience.
• 8+ years of Product Management, Healthcare Technology, Clinical Operations, Utilization Management, or related experience.
• Demonstrated expertise in Medical Prior Authorization and/or Electronic Prior Authorization (ePA) workflows.
• Strong understanding of healthcare payer operations, utilization management processes, and clinical review workflows.
• Experience interpreting and implementing CMS regulations, healthcare interoperability requirements, and regulatory-driven product capabilities.
• Proven experience developing product strategies, product visions, and roadmaps while delivering measurable business outcomes.
• Experience leading complex cross-functional initiatives involving clinical, operational, technology, compliance, and business stakeholders.
• Demonstrated ability to gather, prioritize, and translate business and regulatory requirements into actionable product solutions.
• Strong stakeholder management, communication, and executive presentation skills.
• Ability to influence and drive alignment across highly matrixed organizations.
• Strong analytical, problem-solving, and decision-making capabilities.
• Proven ability to manage multiple priorities and drive execution in complex environments.

Preferred Qualifications

• Experience leading Prior Authorization modernization, automation, or digital transformation initiatives.
• Experience with healthcare interoperability standards and technologies, including FHIR, APIs, HL7, and related healthcare data exchange frameworks.
• Experience supporting CMS interoperability initiatives and regulatory mandates.
• Knowledge of provider workflow integration and provider-facing healthcare technology solutions.
• Experience partnering with industry organizations, clearinghouses, or interoperability vendors.
• Experience driving organizational change and adoption of healthcare technology solutions.
• MBA, MHA, RN, PharmD, or other relevant advanced degree.

Work at Home Requirements

To ensure effective remote work, the self-provided internet service must meet the following criteria: at minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps; wireless, wired cable, or DSL connection is suggested. In certain roles, the minimum recommended internet speed may not be sufficient for business needs, and Humana reserves the right to require associates to upgrade their internet service if necessary. Work must be conducted from a dedicated space free of ongoing interruptions to protect member PHI/HIPAA information.

While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Schedule

Scheduled Weekly Hours: 40

Pay

The pay range for this full-time (40 hours per week) position is $126,300 - $173,700 per year. The range may be higher or lower based on geographic location, and individual pay will vary based on demonstrated job-related skills, knowledge, experience, education, and certifications. This role is also eligible for a bonus incentive plan based on company and/or individual performance.

Benefits

Humana offers competitive benefits designed to support whole-person well-being, including:

• Medical, dental, and vision benefits
• 401(k) retirement savings plan
• Paid time off (including paid holidays, company holidays, and personal holidays)
• Paid parental and caregiver leave
• Short-term and long-term disability
• Life insurance