Product Manager, Prior Authorizations

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

We are seeking a Product Manager with expertise in prior authorization workflows and interoperability. This role will focus on implementing interoperable solutions that streamline prior authorizations, medical necessity reviews, and payer-provider workflows while ensuring compliance with regulatory guidelines. The ideal candidate will bridge the gap between business and technical teams to optimize prior authorization processes and reporting capabilities.

You will serve as the subject matter expert (SME) for prior authorization workflows and interoperability standards, bridging business and technical teams to deliver innovative solutions that meet CMS mandates and industry needs.

Sponsorship, in any form, is not available for this position.

Why you want to work on this team:

• Work on cutting-edge solutions that have the potential to reshape prior authorization processes across the healthcare industry.
• Engage in meaningful work that drives disruption, accountability, and positive change for payers and providers.
• Be part of a team that values innovation and collaboration, positioning Availity as a leader in interoperability and burden reduction.

To be qualified for this position you have:

• 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.

You will set yourself apart with:

• Product background highly preferred.
• 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.

What you will be doing:

• Product Strategy & Vision: Define and communicate a clear product roadmap aligned with CMS requirements, industry trends, and organizational goals.
• Requirements & Specifications: 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.
• Cross-Functional Leadership: Collaborate with engineering, data, and delivery teams to ensure timely, compliant, and scalable product releases.
• Industry Expertise: Serve as the subject matter expert on prior authorization workflows and FHIR standards; provide guidance internally and externally.
• Customer & Market Insight: Monitor CMS mandates, industry trends, and client feedback to inform product decisions and prioritize features.
• Pilot & Launch Oversight: Lead pilots, define KPIs/OKRs, and drive successful go-to-market strategies.
• Reporting & Analytics: Define product performance metrics and partner with data teams to deliver actionable insights for ROI and gainshare.
• Stakeholder Communication: Align executives, clients, and internal teams on product vision, progress, and outcomes.

Availity culture and benefits:

• Availity is a certified "Great Place to Work"! Culture is important to us and there are many ways for you to make your mark here!
• Availity is a culture of continuous learning. We have many resources and experts in our tech stack and in our industry that can help get you there too!
• We offer a competitive salary, bonus structure, generous HSA company contribution, healthcare, vision, dental benefits and a 401k match program that you can take advantage of on day one!
• We offer unlimited PTO for salaried associates + 9 paid holidays. Hourly associates start at 19 days of PTO and go up from there with all the same holiday benefits.
• Interested in wellness? We allow our associates to reimburse up to $250/year for gym memberships, participation in racing events, weight management programs, etc.
• Interested in furthering your education? We offer education reimbursement!
• Availity offers Paid Parental Leave for both moms and dads, both birth parents and adoptive parents.
• Want to work for an organization that gives back to the community? You're at the right place! Availity partners with various organizations, both locally and nationally, to raise awareness, funds and morale as our staff members volunteer their time and funds to engage the organizations campaign.