The Product Manager – Clinical & Authorization Platforms owns the strategy, roadmap, and execution of RxSense’s clinical rules infrastructure and prior authorization capabilities.
This role is responsible for the platform functionality that enables clients to configure, operationalize, and scale their clinical policies and utilization management programs.
Ensure accurate implementation of client-defined clinical criteria into configurable system logic.
Design scalable configuration models that support multiple enterprise clients without degrading performance.
Maintain consistency between formulary integration, clinical edits, and authorization workflows.
Lead the evolution of electronic PA submission, review, approval/denial, exception, and appeals processes.
Define and monitor KPIs that measure workflow efficiency, automation, and rule effectiveness.

4+ years of experience in a PBM, health plan, or healthcare technology environment with direct exposure to prior authorization and utilization management workflows.
4+ years working within agile product teams, healthcare operations, or related environments.
Experience working with clinical rules engines, decision support systems, or authorization platforms.
Strong understanding of how clinical criteria are operationalized within adjudication and workflow systems.
Familiarity with ePA standards and healthcare interoperability (e.g., NCPDP SCRIPT, FHIR).
Experience operating within agile product environments and managing roadmaps/backlogs in JIRA (or similar tools).
Proven ability to communicate effectively across engineering, clinical, operational, and executive stakeholders.
Strategic mindset with the ability to connect platform capabilities to client needs and business growth objectives.

RxSense believes that a diverse workforce is a more talented and productive workforce.
We are an Equal Opportunity and Affirmative Action employer.
Our recruitment process is free from discriminatory hiring practices.

Product Manager, Clinical & Authorization

Key skills