Product Manager - Prior Authorization & Interoperability

Availity; United States; On-site; USD 120,000 - 180,000; Full time

Benefits offered by this job

Great Place to Work

HSA contribution

Healthcare coverage

Vision and dental benefits

401k match

Unlimited PTO

Paid holidays

Education reimbursement

Parental leave

Job summary

Availity is seeking a Product Manager with deep expertise in prior authorization workflows and interoperability to lead cross-functional efforts across CMS mandates and industry standards. You will bridge business and technical teams to design roadmaps, translate requirements into API specs, and drive pilots and go-to-market strategies.

The role emphasizes strong technical acumen, regulatory familiarity, and a proven track record in healthcare technology, with a focus on payer-provider workflows

Qualifications

• Minimum 5 years of product management experience, preferably with client-facing healthcare tech.
• Deep expertise in prior authorization workflows; required for consideration.
• Strong technical background with CMS 0057-F requirements for prior authorization and X12 278 EDI / FHIR transactions.
• Knowledge of EHR systems and utilization management platforms and vendors.
• Ability to gather and describe market requirements and obtain feedback from technical staff and customers.
• Business acumen to contribute to business cases, assess feasibility and ROI.
• Familiarity with regulatory requirements and compliance standards.
• Proven ability to lead cross-functional initiatives and influence stakeholders.

Responsibilities

• Define and communicate product roadmap aligned with CMS requirements and industry trends.
• Translate requirements into user stories, acceptance criteria, and API specs for engineering teams; validate interoperability standards (X12 278, FHIR CRD/DTR/PAS).
• Collaborate with engineering, data, and delivery teams for timely, compliant releases.
• Serve as SME on prior authorization workflows and FHIR standards; provide guidance internally and externally.
• Monitor CMS mandates and client feedback to inform decisions and prioritise features.
• Lead pilots, define KPIs/OKRs, and drive go-to-market strategies.
• Define product performance metrics and partner with data teams to deliver ROI insights.
• Align executives, clients, and internal teams on vision, progress and outcomes.

Skills

prior authorization workflows

interoperability

cross-functional leadership

business case development

regulatory compliance

Tools

CMS 0057-F

X12 278 EDI

FHIR

Job description

Availity is seeking a Product Manager with deep expertise in prior authorization workflows and interoperability to lead cross-functional efforts across CMS mandates and industry standards. You will bridge business and technical teams to design roadmaps, translate requirements into API specs, and drive pilots and go-to-market strategies.

The role emphasizes strong technical acumen, regulatory familiarity, and a proven track record in healthcare technology, with a focus on payer-provider workflows