Senior Product Director, Prior Authorization

Role Description

We are seeking a Senior Product Director, Prior Authorization to lead the strategy, execution, and scale of our Utilization Management (UM) product portfolio during a pivotal moment of industry transformation. This leader will own the product vision and roadmap for solutions that modernize how payers and providers manage authorization workflows, clinical decisioning, automation, and administrative burden.

• The ideal candidate has direct experience building and scaling healthcare technology products in prior authorization, utilization management, payer-provider workflows, interoperability, or AI-enabled clinical operations.
• Success requires both deep domain expertise and the ability to lead cross-functional teams through market discovery, roadmap prioritization, product development, commercialization, and continuous optimization.

Sponsorship, in any form, is not available for this position.

Location: Remote, US

Why you want to work on this team:

• Work on cutting-edge solutions that have the potential to reshape prior authorization processes across the healthcare industry.
• Engage in meaningful work that drives disruption, accountability, and positive change for payers and providers.
• Be part of a team that values innovation and collaboration, positioning Availity as a leader in interoperability and burden reduction.

Qualifications

• Bachelor’s degree required; advanced degree (MBA, MHA, MPH, RN, MD) strongly preferred.
• Direct experience building, launching, or scaling prior authorization products, UM platforms, clinical workflow tools, or payer-provider authorization solutions.
• Proven ability to build 0-to-1 products from concept to launch, including market validation, roadmap development, MVP execution, and scaling adoption in prior authorization, UM, or healthcare workflow technology.
• 10+ years of experience in healthcare product management, medical management, or utilization management.
• 5+ years in a senior product leadership role.
• Deep expertise in prior authorization, utilization review, and medical cost containment strategies.
• Strong understanding of managed care, payer operations, and healthcare regulations.
• Experience working with clinical teams and medical policy development.
• Background in digital health, automation, or AI-enabled clinical workflows.
• Proven success launching complex, regulated healthcare products at scale.
• Strategic product leadership and executive-level communication.
• Ability to translate clinical and regulatory complexity into usable products.
• Strong analytical and financial acumen.
• Collaborative leadership across clinical, technical, and business teams.
• Comfort operating in highly regulated, fast-changing environments.

Requirements

• Designed or scaled AI-enabled, rules-based, or automated clinical decisioning workflows within a regulated healthcare technology environment.
• Led product innovation that improved authorization turnaround times, auto-approval rates, provider experience, administrative burden, or medical cost savings.

What you will be doing:

• Product Strategy & Vision:
  • Defining and owning the long-term product vision and roadmap for medical cost containment and authorization capabilities.
  • Aligning product strategy with enterprise affordability, quality, and growth goals.
  • Identifying market trends, regulatory changes, and competitive opportunities impacting utilization management and authorization.
• Product Development & Lifecycle Management:
  • Leading the end-to-end product lifecycle from concept through launch, optimization, and sunset.
  • Translating clinical, operational, and regulatory requirements into clear product requirements and prioritization.
  • Partnering with engineering and data teams to deliver scalable, configurable authorization and cost containment solutions.
  • Ensuring products support evidence-based medicine, medical policy, and evolving clinical guidelines.
• Medical Cost Containment & Authorization:
  • Overseeing products supporting prior authorization, concurrent review, retrospective review, and specialty management.
  • Driving innovation in automation, rules engines, AI-assisted review, and straight-through processing.
  • Balancing cost containment objectives with access to care, provider experience, and member satisfaction.
• Cross-Functional Leadership:
  • Collaborating with stakeholders across products to ensure integrity and regulatory adherence.
  • Partnering with Leadership & Finance to quantify savings impact and ROI.
  • Supporting Sales and Client Management with product positioning, differentiation, and client engagement.
• Governance, Compliance & Quality:
  • Ensuring products comply with federal and state regulations (e.g., CMS, NCQA, URAC, state DOI requirements).
  • Supporting audit readiness and accreditation standards related to utilization management.
  • Establishing KPIs and governance models to monitor product performance, outcomes, and quality.
• Team Leadership:
  • Building, mentoring, and leading high-performing product management teams.
  • Fostering a culture of accountability, innovation, and continuous improvement.

Benefits

• Availity is a certified “Great Place to Work”! Culture is important to us and there are many ways for you to make your mark here!
• We have several Culture teams, a Young Professionals Group, and various ways to engage with fellow Availity associates.
• Availity is a culture of continuous learning with many resources and experts in our tech stack and industry.
• Casual dress code; you can wear jeans.
• Competitive salary, bonus structure, generous HSA company contribution, healthcare, vision, dental benefits, and a 401k match program available on day one.
• Unlimited PTO for salaried associates + 9 paid holidays; hourly associates start at 19 days of PTO.
• Reimbursement up to $250/year for gym memberships, racing events, weight management programs, etc.
• Education reimbursement available.
• Paid Parental Leave for both birth and adoptive parents.
• Community engagement through partnerships with various organizations.

Next steps:

After you apply, you will receive text/email messages thanking you for applying and updates on your recruitment process.

Interview process:

• Recruiter Recorded Video Pre-Screen
• Video Interview with Hiring Manager
• Video Panel Interview
• Video Interview with Chief Product Officer
• Video Interview with Chief Operating Officer
• Video Interview with Chief Technology Officer

Disclaimers:

• Availity is an equal opportunity employer and makes decisions in employment matters without regard to protected classifications.
• Availity is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
• Federal law requires all employers to verify the identity and employment eligibility of all persons hired to work in the United States.