CLINICAL PRODUCT OWNER (PRIOR AUTHORIZATIONS SME)

Glint Tech Solutions LLC • Plano, TX

9d • Remote

About The Position

Our client is seeking a highly experienced Clinical Product Owner and Business Integration Lead with deep expertise in clinical prior authorizations to drive a complex, cross-functional initiative focused on the complete analysis and potential redesign of the prior authorization process. This is a lead-level, fully remote position requiring a true SME in Prior Authorizations, FACETS, 278 transactions, and Claims Processing. The ideal candidate brings 15+ years in healthcare and payer operations, with the last 8+ years in a Clinical Product Manager capacity. Day-to-day responsibilities include engaging clinical, business, and IT stakeholders to analyze current PA workflows, identify pain points, and drive meaningful process improvements.

Requirements

• 15+ years in healthcare delivery, payer operations, UM, or PA programs
• Last 8+ years as a Clinical Product Manager or Business Integration Lead
• End-to-end knowledge of Clinical Prior Authorizations — critically important
• FACETS expertise
• Claims processing knowledge
• 278 transaction experience
• Basic working knowledge of GuidingCare
• Excellent communication, stakeholder management, and executive-level reporting skills
• Must be US-based

Nice To Haves

• Experience leading prior authorization process redesign initiatives
• Background working with large healthcare payers or managed care organizations
• Familiarity with UM/PA regulatory and compliance frameworks

Responsibilities

• Lead cross-functional meetings with clinical, business, and IT stakeholders to analyze current prior authorization processes
• Identify pain points and drive resolutions to improve PA workflows end-to-end
• Support complete analysis and potential redesign of the client's prior authorization process
• Serve as primary SME for Clinical Prior Authorizations, FACETS, 278 transactions, and Claims Processing
• Deliver executive-level reporting and manage complex, multi-stakeholder initiatives
• Translate clinical and business requirements into actionable product and integration strategies

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: No Education Listed