Product Manager, Authorizations (Remote)

Product Strategy & Vision

Define and communicate a clear product roadmap aligned with CMS requirements, industry trends, and organizational goals.

Requirements & Specifications

• Gather and document business requirements through stakeholder interviews and workflow analysis.
• Translate requirements into user stories, acceptance criteria, and API specifications for engineering teams.
• Validate interoperability standards (X12 278, FHIR CRD/DTR/PAS) for transactions between EHRs, Availity, and payer/vendor systems.

Cross-Functional Leadership

• Collaborate with engineering, data, and delivery teams to ensure timely, compliant, and scalable product releases.

Industry Expertise

• Serve as the subject matter expert on prior authorization workflows and FHIR standards; provide guidance internally and externally.

Pilot & Launch Oversight

• Lead pilots, define KPIs/OKRs, and drive successful go-to-market strategies.

Reporting & Analytics

• Define product performance metrics and partner with data teams to deliver actionable insights for ROI and gainshare.

Stakeholder Communication

• Align executives, clients, and internal teams on product vision, progress, and outcomes.

Technical Background

• Deep expertise in prior authorizations workflows.
• Strong technical background with an understanding of the CMS 0057-F requirements for prior authorization and the X12 278 EDI and FHIR prior authorization (CRD, DTR, and PAS) transactions.
• Knowledge of EHR systems and utilization management platforms and vendors.
• Technical acumen, the ability to gather and describe market requirements and get feedback from technical staff and customers.
• Business acumen: ability to contribute to a business case, evaluate feasibility & scalability, and driving ROI.
• Familiarity with regulatory requirements and compliance standards.
• Proven ability to lead cross-functional initiatives and influence stakeholders.

Other Skills

• Product background highly preferred.
• Proficiency in analyzing data and finding actionable insights.
• Experience with AI-driven utilization management solutions and automation technologies.
• Knowledge of the full revenue cycle is a plus.