Lead Product Owner - Utilization Management (UM)

Company Description
Lumen Solutions Group Inc. is a technology consulting Services company based in Florida. We provide a wide array of experienced business and IT professionals supporting clients from solution design to implementation and support. We specialize in professional IT consulting services, IT Staffing, Business/IT Strategy, Business Process Blueprints, Enterprise Architecture, and Enterprise Transformation.


Job Title: Product Owner - Utilization Management (UM) / Prior Authorization (PA)
Location: Baltimore, MD (Hybrid)
Job Type: Contract

Job Summary
We are seeking an experienced Product Owner with strong expertise in Healthcare Payer Operations, Utilization Management (UM), and Prior Authorization (PA). The ideal candidate will lead enterprise healthcare initiatives focused on optimizing end-to-end prior authorization workflows, payer integrations, and claims processing while collaborating closely with business, clinical, and technical teams. This role requires deep knowledge of GuidingCare, Facets, EDI 278 transactions, and Agile product delivery. The Product Owner will drive backlog prioritization, workflow optimization, stakeholder collaboration, and operational improvements across UM and PA programs.


Key Responsibilities

• Lead end-to-end Prior Authorization (PA) and Utilization Management (UM) product initiatives.
• Manage product backlog, roadmap, sprint planning, and Agile ceremonies.
• Collaborate with Claims, IT, Clinical, Technical, and Operations teams to deliver scalable healthcare solutions.
• Own and optimize the complete PA workflow from GuidingCare into Facets, including claims matching and authorization processing.
• Translate business requirements into actionable user stories and product enhancements.
• Drive workflow optimization, automation initiatives, and operational efficiency improvements.
• Monitor KPIs including turnaround time (TAT), denials, auto-decision rates, and provider experience metrics.
• Support healthcare integrations, EHR interoperability, and compliance initiatives.
• Work closely with stakeholders and leadership teams to ensure successful product delivery and business alignment.

Required Qualifications

• 15+ years of experience in Healthcare Payer Operations, Utilization Management (UM), Prior Authorization (PA), or Healthcare Delivery.
• 8-10+ years of Product Owner/Product Management experience in healthcare environments.
• Strong expertise in end-to-end Prior Authorization workflows and payer operations.
• Hands-on experience with GuidingCare and Facets - MUST HAVE.
• Strong understanding of how Prior Authorization flows into Facets and how claims matching is processed within Facets - MUST HAVE.
• Experience working with Claims, IT, Clinical, and Technical teams.
• Strong knowledge of EDI 278 transactions and healthcare interoperability standards.
• Expertise in Agile/Scrum methodologies, backlog management, and roadmap planning.
• Experience with Jira, MS Office Suite, and enterprise collaboration tools.
• Excellent communication, stakeholder management, and problem-solving skills.
• CSPO (Certified Scrum Product Owner) certification preferred.

Lumen Solutions Group Inc is an equal opportunity employer. All qualified applicants will be considered for employment without regard to any legally protected status.