Product Manager – Utilization Management

5 hours ago

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Availity

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Healthcare Insurance • SaaS • API

Availity is a leading health information network that connects payers, providers, and technology partners in the healthcare industry. By facilitating over 13 billion clinical, administrative, and financial transactions annually, Availity streamlines payer-provider collaboration and enhances patient care through an integrated provider engagement platform. The company's solutions leverage artificial intelligence and interoperability to automate processes such as prior authorizations, revenue cycle management, and payment accuracy, ultimately reducing costs and improving efficiency across the healthcare ecosystem.

1001 - 5000 employees

Founded 2000

⚕️ Healthcare Insurance

☁️ SaaS

🔌 API

💰 Secondary Market on 2021-07

📋 Description

• Develop and enhance UM solutions that streamline prior authorizations, medical necessity reviews, and payer-provider workflows • Ensure compliance with regulatory guidelines • Bridge the gap between business, clinical, and technical teams to optimize utilization management processes and reporting capabilities • Manage pilot oversight with pilot partners to drive business requirements • Create and monitor KPI/OKR’s, GTM planning, scaling, etc. • Liaise with clinical teams for CPT and Medical policy questions • Act as the Utilization Management workflow SME • Prioritize product feature build based on industry trends and client feedback • Revamp standard client reporting package and build out product performance reporting • Support sales, marketing and client success teams with product demos, training, and analytics driven insights

🎯 Requirements

• Extensive experience in utilization management (UM) • Strong clinical background: inpatient and outpatient • Strong understanding of prior authorizations workflows, medical necessity reviews, and payer policies • Knowledge of EHRs, claims processing systems, and utilization management platforms • Business acumen: ability to contribute to business cases, evaluate feasibility & scalability, assess and drive ROI, background in contracting • Experience with AI-driven UM solutions and automation technologies • Strong understanding of utilization metrics, value-based care models, and population health analytics • Knowledge of regulatory and accreditation requirements • Ability to drive work with limited oversight • Desire to work in a fast-paced environment with multiple competing priorities

🏖️ Benefits

• Competitive salary • Bonus structure • Generous HSA company contribution • Healthcare, vision, and dental benefits • 401k match program on day one • Unlimited PTO for salaried associates + 9 paid holidays • Hourly associates start at 19 days of PTO with holiday benefits • Wellness reimbursement up to $250/year for gym memberships, events, etc. • Education reimbursement • Paid Parental Leave for birth and adoptive parents