[Remote] Product Manager, Prior Authorizations
Note: The job is a remote job and is open to candidates in USA. Availity is a company focused on innovative healthcare solutions, and they are seeking a Product Manager with expertise in prior authorization workflows and interoperability. This role involves implementing solutions that streamline prior authorizations and ensuring compliance with regulatory guidelines while collaborating with both business and technical teams.
Responsibilities
- Define and communicate a clear product roadmap aligned with CMS requirements, industry trends, and organizational goals
- 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
- Collaborate with engineering, data, and delivery teams to ensure timely, compliant, and scalable product releases
- Serve as the subject matter expert on prior authorization workflows and FHIR standards; provide guidance internally and externally
- Monitor CMS mandates, industry trends, and client feedback to inform product decisions and prioritize features
- Lead pilots, define KPIs/OKRs, and drive successful go-to-market strategies
- Define product performance metrics and partner with data teams to deliver actionable insights for ROI and gainshare
- Align executives, clients, and internal teams on product vision, progress, and outcomes
Skills
- Have a minimum of 5 years' experience in Product Management preferably with client facing experience within healthcare technology
- 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
- 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
Benefits
- We offer a competitive salary, bonus structure, generous HSA company contribution, healthcare, vision, dental benefits and a 401k match program that you can take advantage of on day one!
- We offer unlimited PTO for salaried associates + 9 paid holidays. Hourly associates start at 19 days of PTO and go up from there with all the same holiday benefits.
- We allow our associates to reimburse up to $250/year for gym memberships, participation in racing events, weight management programs, etc.
- We offer education reimbursement!
- Availity offers Paid Parental Leave for both moms and dads, both birth parents and adoptive parents.
Company Overview