Director Product Management - Prior Authorization

TSV Consulting LLC is partnering with an innovative Health Tech company that utilizes AI and ML to enhance Prior Authorization reviews for health plans and PBMs. The Director of Product Management will define and own the product vision and strategy, oversee product execution, and engage with clients and stakeholders to ensure the product meets their needs.

Responsibilities:

• Define and own the overall product vision, strategy, and multi-year roadmap across the full Banjo Health platform - spanning PA, Medical PA, PA Renewals, Formulary, FWA, Grievances and Appeals, Utilization Management, Care Management, Provider Portal, and agentic AI capabilities
• Translate company strategy into a prioritized product roadmap, communicate direction clearly to engineering, clinical, and executed stakeholders
• Balance a portfolio of initiatives across compliance-driven requirements, growth features, and innovative bets - making clear, defensible prioritization decisions across competing demands
• Monitor industry trends including CMS mandates, NCPDP standards, ePA adoption, PBM market dynamics, and AI in healthcare to identify product opportunities and risks
• Own the product P&L perspective - understand how product decisions connect to revenue, retention, and cost to serve
• Direct and oversee the product team's execution — guiding user story development, acceptance criteria, sprint planning, and backlog prioritization to ensure engineering always has clear, well-defined work aligned to product goals
• Define the technical and functional requirements for key integrations and features; delegate specification and story-writing to product staff while maintaining accountability for quality and accuracy
• Engage directly with engineering on architecture decisions, technical tradeoffs, and scope calls — serving as the decision-maker on product direction when tradeoffs arise
• Review and approve product specifications, ensuring completeness, compliance alignment, and fidelity to the roadmap before engineering begins work
• Establish the team's ways of working — ceremonies, documentation standards, definition of done, and cross-functional collaboration norms
• Serve as the primary product voice in client conversations — gather feedback, define solutions, and translate client needs into actionable product requirements
• Support client implementations by collaborating with onboarding teams to configure business rules, user roles, and workflow automations in the Banjo platform
• Engage directly with Medicaid and Medicare plan stakeholders to understand regulatory constraints and design compliant solutions
• Represent Banjo Health product externally including customer advisory engagements, partner discussions, and industry forums
• Define and track product KPIs including feature adoption, transaction throughput, system performance, and client satisfaction
• Analyze user behavior and operational data to surface insights that refine the product strategy and prioritization
• Drive a culture of experimentation and iteration, using data to validate assumptions and improve outcomes
• Define and own the AI product strategy for Banjo Health — identify where AI and machine learning can meaningfully improve PA processing, clinical decision support, auto-determination accuracy, FWA detection, and operational efficiency
• Drive the roadmap for Banjo Assistant, our agentic AI capability — including intelligent PA intake, policy document generation, criteria matching, composer updates, and audit log automation
• Evaluate, pilot, and integrate AI capabilities including large language models (LLMs), NLP for clinical note parsing, predictive models for PA outcome forecasting, and agentic workflows that reduce manual touchpoints across the clinical management lifecycle
• Partner with engineering to assess AI/ML vendor solutions and build-vs-buy decisions, ensuring alignment with HIPAA, CMS AI guidance, and responsible AI principles
• Stay current on AI regulation in healthcare including CMS guidance on AI-assisted prior authorization, ONC interoperability rules, and emerging frameworks for algorithmic transparency and bias mitigation
• Champion a pragmatic approach to AI — grounding investment in measurable outcomes for clients, members, and clinical staff rather than technology for its own sake
• Ensure the platform meets applicable regulatory requirements including HIPAA, CMS prior authorization mandates, 508 accessibility standards, and NCPDP transaction standards
• Partner with engineering, legal, and compliance to embed security and regulatory review into the product lifecycle
• Build and grow the product function as the organization scales — define the PM hiring bar, onboarding playbook, and team rituals
• Coach and develop product team members, providing structured feedback and career development support
• Establish cross-functional working norms across Product, Engineering, Clinical, and Client Success

Requirements:

• 6+ years of product management experience, with at least 2 years in a senior or lead PM role
• 4+ years of experience in healthcare technology with deep expertise across the PBM and health plan ecosystem — including prior authorization, formulary management, fraud waste & abuse, utilization management, grievances & appeals, or care management
• Demonstrated experience leading product teams through Agile execution — including backlog management, sprint planning, and maintaining high-quality product specifications in Jira or equivalent tools
• 4+ years of experience with system integrations using APIs and structured data formats; ability to engage in technical design discussions with engineering teams
• 2+ years of experience onboarding Medicaid and/or Medicare plans and designing solutions that meet CMS regulatory requirements
• Proven track record of owning a product roadmap end-to-end and delivering results in a fast-paced, resource-constrained environment
• Experience with ePA vendors such as Surescripts and drug information databases such as Medispan or First Databank (FDB)
• Demonstrated knowledge of AI and machine learning applications in healthcare, including at least one shipped AI-powered product feature or capability
• Familiarity with responsible AI principles, healthcare AI regulation (CMS, ONC), and HIPAA-compliant data practices for ML model development and deployment
• Experience leading a product team and directly managing other PMs
• Familiarity with NCPDP standards, FHIR standards and electronic PA transaction processing
• Hands-on experience defining or shipping agentic AI features — including LLM-powered workflows, NLP for clinical document processing, or AI-assisted decision support in a healthcare setting
• Experience at a startup or high-growth company where product leaders operate hands-on across strategy and execution
• Proficiency with design and prototyping tools such as Loveable, Figma or Balsamiq
• Strong executive communication skills with demonstrated experience presenting to C-suite, boards, or enterprise clients
• Active engagement in relevant professional communities — e.g., HIMSS, AMCP, NCPDP work groups, CHAI, or product leadership communities such as Mind the Product or Product-Led Alliance — demonstrating ongoing learning and industry networking