Lead Product Manager - Interoperability Prior Authorizations

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Lead Product Manager - Interoperability Prior Authorization based in the United States.

This is a high-impact product leadership role focused on modernizing medical and electronic prior authorization experiences across the healthcare ecosystem.
You will define product strategy, roadmaps, and execution plans that improve provider and member experiences while reducing administrative complexity.
The role sits at the intersection of healthcare payer operations, clinical workflows, technology, interoperability, and regulatory compliance.
You’ll collaborate with clinical, utilization management, operations, technology, compliance, and external technology partners to deliver scalable solutions.
A key focus will be advancing interoperable prior authorization capabilities while responding to evolving CMS requirements and industry standards.
You’ll use data, customer insights, and operational metrics to prioritize investments and demonstrate measurable outcomes.
This is an opportunity to influence complex healthcare transformation initiatives within a highly collaborative and matrixed environment.

• Define and execute the product vision, strategy, and roadmap for medical prior authorization and electronic prior authorization (ePA) capabilities.
• Partner with clinical, business, operational, technology, compliance, provider, and utilization management stakeholders to identify opportunities and improve authorization workflows and customer experiences.
• Translate complex clinical, operational, business, and regulatory requirements into clear product solutions, business requirements, user journeys, implementation plans, and measurable success criteria.
• Lead complex cross-functional initiatives from discovery through delivery, collaborating closely with Product Owners, Engineering, and delivery teams to ensure successful execution.
• Drive simplification, automation, and operational efficiency across prior authorization processes while reducing administrative burden for providers and members.
• Build and maintain strategic relationships with EHR/EMR vendors, interoperability partners, industry organizations, clearinghouses, and other external stakeholders.
• Monitor CMS regulations, interoperability requirements, healthcare technology trends, and industry developments to ensure product strategies remain compliant and forward-looking.
• Establish, monitor, and communicate product performance metrics covering provider experience, adoption, operational efficiency, compliance, and business outcomes.
• Present product strategy, roadmap priorities, risks, progress, and value realization to senior and executive leadership.
• Identify opportunities for continuous improvement, organizational change, and technology adoption that enhance transparency and streamline healthcare authorization experiences.

Requirements:

• Bachelor's degree or equivalent practical experience.
• 8+ years of experience in Product Management, Healthcare Technology, Clinical Operations, Utilization Management, or a related field.
• Demonstrated expertise with medical prior authorization and/or electronic prior authorization workflows.
• Strong understanding of healthcare payer operations, utilization management, clinical review processes, and provider workflows.
• Experience interpreting and implementing CMS regulations, healthcare interoperability requirements, and regulatory-driven product capabilities.
• Proven ability to develop product strategies, visions, and roadmaps while delivering measurable business outcomes.
• Experience leading complex cross-functional programs involving clinical, operational, technology, compliance, and business stakeholders.
• Strong requirements-gathering and prioritization skills, with the ability to translate business and regulatory needs into actionable product solutions.
• Excellent stakeholder management, communication, presentation, and influencing skills, particularly within highly matrixed organizations.
• Strong analytical, problem-solving, and decision-making capabilities, with the ability to manage competing priorities in complex environments.
• Experience with prior authorization modernization, automation, digital transformation, or similar healthcare technology initiatives is preferred.
• Familiarity with healthcare interoperability standards and technologies such as FHIR, APIs, HL7, and related healthcare data-exchange frameworks is preferred.
• Experience supporting CMS interoperability initiatives and regulatory mandates is a plus.
• Experience with provider-facing healthcare technology, EHR/EMR integrations, clearinghouses, or interoperability vendors is preferred.
• Experience driving organizational change and adoption of new healthcare technology solutions is advantageous.
• An MBA, MHA, RN, PharmD, or another relevant advanced degree is a plus.

Benefits:

• Annual base salary range of $126,300–$173,700 , depending on geographic location, experience, education, certifications, and other job-related factors.
• Eligibility for a bonus incentive plan based on company and/or individual performance.
• Comprehensive medical, dental, and vision coverage.
• 401(k) retirement savings plan.
• Paid time off, company holidays, and personal holidays.
• Paid parental and caregiver leave.
• Short-term and long-term disability coverage.
• Life insurance and additional employee benefits supporting whole-person wellbeing.
• Fully remote work opportunity available nationwide within the United States.
• 40-hour standard workweek.
• Occasional travel to company offices may be required for training, meetings, or other business needs.
• Remote employees must maintain reliable internet access, with at least 25 Mbps download and 10 Mbps upload speeds recommended.
• Dedicated, interruption-free workspace required to protect confidential healthcare and HIPAA-related information.

How Jobgether works:

We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.

We appreciate your interest and wish you the best!

Why Apply Through Jobgether?

Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.

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