Product Manager, Prior Authorizations

Availity delivers revenue cycle and related business solutions for healthcare professionals, aiming to enhance patient care. The Product Manager role focuses on implementing interoperable solutions for prior authorizations and medical necessity reviews, bridging business and technical teams to optimize processes.

Responsibilities:

• Define and communicate a clear product roadmap aligned with CMS requirements, industry trends, and organizational goals
• Gather and document business requirements through stakeholder interviews and workflow analysis
• Translate requirements into user stories, acceptance criteria, and API specifications for engineering teams
• Validate interoperability standards (X12 278, FHIR CRD/DTR/PAS) for transactions between EHRs, Availity, and payer/vendor systems
• Collaborate with engineering, data, and delivery teams to ensure timely, compliant, and scalable product releases
• Serve as the subject matter expert on prior authorization workflows and FHIR standards; provide guidance internally and externally
• Monitor CMS mandates, industry trends, and client feedback to inform product decisions and prioritize features
• Lead pilots, define KPIs/OKRs, and drive successful go-to-market strategies
• Define product performance metrics and partner with data teams to deliver actionable insights for ROI and gainshare
• Align executives, clients, and internal teams on product vision, progress, and outcomes

Requirements:

• Have a minimum of 5 years' experience in Product Management preferably with client facing experience within healthcare technology
• Deep expertise in prior authorizations workflows. This is required to be considered for the role
• Strong technical background with an understanding of the CMS 0057-F requirements for prior authorization and the X12 278 EDI and FHIR prior authorization (CRD, DTR, and PAS) transactions
• Knowledge of EHR systems and utilization management platforms and vendors
• Technical acumen, the ability to gather and describe market requirements and get feedback from technical staff and customers
• Business acumen: ability to contribute to a business case, evaluate feasibility & scalability, and driving ROI
• Familiarity with regulatory requirements and compliance standards
• Proven ability to lead cross-functional initiatives and influence stakeholders
• Product background highly preferred
• Familiarity with Agile/Scrum, product management tools (Jira, Aha), and EHR systems
• Proficiency in analyzing data and finding actionable insights
• Experience with AI-driven utilization management solutions and automation technologies
• Knowledge of the full revenue cycle is a plus