Senior Product Manager - Value-Based Care & AI

Why We Need You – The Mission

Healthcare quality is complex. Medisolv helps make it manageable—and actionable.

We partner with hospitals, health systems, ACOs, and payers to bring clarity to quality data, connecting clinical and claims information into a single, reliable view. More than 1,800 organizations and 130M+ patient records rely on Medisolv to measure, report, and improve performance across 500+ measures tied to CMS, The Joint Commission, and other programs.

What You’ll Accomplish – Your Performance Objectives

• First 30 Days: Build a deep understanding of Medisolv’s data ecosystem and CMS measure logic (HEDIS, Pharmacy, CAHPS/HOS).
• First 3 Months: Design and prototype AI agents to identify care gaps and predict Star Rating risks. Stand up the foundation of the payer data core from fragmented datasets. Develop initial CMS measure calculation engines and pilot action-oriented workflows.
• First 6 Months: Deploy production-ready AI agents that connect insights directly to gap-closing actions. Expand and stabilize the payer data core and measurement automation. Implement orchestrated workflows and mature HITL guardrails.
• First 12 Months: Optimize AI performance with feedback loops and expand to more advanced use cases. Mature the data platform into a scalable, real-time decisioning engine. Drive measurable improvements in Star Ratings and value-based care outcomes.

Who We’re Looking For – The Competencies That Matter

• Payer & VBC Domain Fluency: 5+ years of product management experience handling health plan data and VBC provider quality metrics. Deep understanding of risk adjustment, utilization management, and how risk-bearing entities operate.
• CMS Quality & Star Ratings Expertise: Knowledge of how CMS calculates MA Star Ratings inside out. Understanding of the math behind cut points, the impact of triple-weighted measures, and how to build data products that move the needle across various CMS measure domains.
• Core Payer Data Comfort: Hands-on experience working with claims, eligibility, and enrollment datasets, and knowledge of how to map these back to quality performance.
• Beyond-the-Dashboard Mindset: Tired of building static BI tools. Want to build proactive software that thinks, adapts, and automates workflows rather than just reporting on them.
• AI & Data Literacy: Understanding of GenAI architectures, RAG, and agentic frameworks (like LangChain, AutoGen, or similar orchestration toolsets). Comfortable talking to engineers about vector databases, APIs, and semantic data layers.
• Trust & Security First: Understand that healthcare data requires extreme care. Know how to build within HIPAA/HITRUST guidelines and ensure AI outputs are accurate, unbiased, and explainable.
• You are a doer: Take initiative, enjoy driving tasks from inception to completion, and use frustration positively to drive solutions.
• Collaborative: Empathetic for colleagues. Demonstrate and influence cross-functional collaboration within the company and seek out opportunities to build relationships with others even when difficult personalities or politics stand in the way.
• Flexible: Understand that at growth stage companies, things will evolve. Be open-minded and adaptable to changing environments as the company grows and scales.
• Growth Mindset: Love a challenge. Intellectual curiosity. Diverse set of interests inside and outside of work. Can articulate areas where they have worked hard on improving themselves over time.
• Resilient: Embrace change. Optimistic. It's not how many times you get knocked down, it's how many times you get up.

How to be a Medisolver – Our Values

• Customer Success Obsession: Commitment to creating a diverse and inclusive workplace. Diversity drives innovation.
• All-Star Team Collaboration: All employees feel valued and respected.
• Continuous Improvement through Curiosity & Data-Driven Learning: Intellectual curiosity and data-driven learning.
• Courage with Kindness: Optimistic and optimistic.
• Execution Focus: We Do Business, Not Just Talk Business.

Medisolv is Committed to Creating a Diverse and Inclusive Workplace

We believe that diversity drives innovation, and we are dedicated to fostering an environment where all employees feel valued and respected.

Candidates must successfully complete a pre-employment background check and be legally authorized to work in the United States, as sponsorship is not available.