Lead Product Manager – Interoperability Prior Authorizations

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🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $126.3k - $173.7k / year

⏰ Full Time

🟠 Senior

✅ Product Manager

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Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.

📋 Description

• Define and execute the product vision, strategy, and roadmap for Prior Authorization and Electronic Prior Authorization capabilities • Partner with business, clinical, operational, and technology stakeholders to improve authorization workflows and customer experiences • Translate clinical, operational, regulatory, and business requirements into product solutions and delivery plans • Lead cross-functional efforts to define business requirements, user journeys, success metrics, and implementation strategies • Collaborate with Product Owners, Engineering, and delivery teams to execute product initiatives • Drive process simplification, automation, and operational efficiency with Utilization Management, Provider, and Operations teams • Build relationships with EMR/EHR vendors, interoperability partners, industry organizations, and external stakeholders • Monitor CMS regulations, interoperability requirements, and industry trends • Establish and track product performance metrics • Communicate product strategy, roadmap priorities, risks, and value realization to senior leadership and executive stakeholders • Drive continuous improvement to enhance transparency, reduce administrative burden, and improve authorization experiences • Travel occasionally to Humana offices for training or meetings

🎯 Requirements

• Bachelor's degree or equivalent experience • 8+ years of Product Management, Healthcare Technology, Clinical Operations, Utilization Management, or related experience • Expertise in Medical Prior Authorization and/or Electronic Prior Authorization workflows • Strong understanding of healthcare payer operations, utilization management processes, and clinical review workflows • Experience interpreting and implementing CMS regulations and healthcare interoperability requirements • Experience developing product strategies, product visions, and roadmaps with measurable business outcomes • Experience leading complex cross-functional initiatives across clinical, operational, technology, compliance, and business stakeholders • Ability to gather, prioritize, and translate business and regulatory requirements into product solutions • Strong stakeholder management, communication, and executive presentation skills • Ability to influence and drive alignment across matrixed organizations • Strong analytical, problem-solving, and decision-making capabilities • Ability to manage multiple priorities and drive execution in complex environments • Preferred: experience with FHIR, APIs, HL7, healthcare data exchange frameworks, provider workflow integration, clearinghouses, interoperability vendors, and healthcare technology adoption • Preferred: MBA, MHA, RN, PharmD, or other relevant advanced degree • Minimum home internet speed of 25 Mbps download and 10 Mbps upload • Dedicated workspace without ongoing interruptions to protect PHI/HIPAA information

🏖️ Benefits

• Bonus incentive plan • Medical benefits • Dental benefits • Vision benefits • 401(k) retirement savings plan • Paid time off • Company holidays • Personal holidays • Paid parental leave • Paid caregiver leave • Short-term disability • Long-term disability • Life insurance • Personal wellness support • Healthcare decision support • Work-from-home arrangement