Product Manager, Clinical Informatics

Amerihealth Caritas•,

1d•Remote

About The Position

The Product Manager, Clinical Informatics drives the strategy, design, and delivery of clinical technology products that power utilization management (UM), care management (CM), quality operations, and member engagement across a multistate Medicaid managed care organization. This role serves as the connective tissue between clinical operations, data engineering, and technology—translating complex regulatory, operational, and clinical requirements into scalable, data-enabled products, automated workflows, and intuitive system configurations that improve financial performance, operational throughput, and healthcare outcomes. Operating at the intersection of product management discipline, clinical informatics expertise, and health plan operations, this role owns the product lifecycle from discovery through adoption—ensuring that every release delivers measurable business value, supports regulatory compliance (including CMS interoperability mandates, NCQA, and HEDIS), and enhances the front-line clinician and member experience.

Requirements

Bachelor’s Degree required
Minimum of 3 years of clinical product management experience for a payor
Experience with clinical workflows
Project management experience using Agile methodology
Experience researching competitors and market trends to guide product strategy, find open gaps, and measure performance against best practices within the industry
Experience defining and tracking KPIs tied to product performance

Responsibilities

Own the clinical product vision, roadmap, and prioritization for assigned domain(s)—UM, CM, quality, and/or interoperability—ensuring alignment with enterprise business plan objectives, regulatory timelines, and market expansion strategy.
Translate business strategy into a scalable product backlog with clearly defined epics, features, and user stories using Agile/iterative delivery practices
Conduct competitive landscape analysis and market scanning to inform product positioning, identify whitespace opportunities, and benchmark against industry-leading Medicaid MCO capabilities.
Define and track KPIs tied to product performance—including cycle time reduction, auto-adjudication rates, clinical throughput, regulatory compliance, and user adoption, using insights to drive continuous improvement.
Drive product alignment with CMS Interoperability and Prior Authorization Final Rule, TEFCA, FHIR-based API requirements, and state-specific Medicaid regulatory mandates.
Collaborate with data engineering and integration teams to ensure clinical data exchange (HL7, FHIR, X12, RAPS/EDPS) meets performance, security, and compliance standards.
Manage product requirements for HEDIS supplemental data capture, NCQA accreditation support, and quality measure reporting.
Support delegation oversight by ensuring vendor-facing products and integrations meet contractual and regulatory requirements.
Facilitate governance forums, cross-functional design sessions, and sprint ceremonies to align product delivery with business, clinical, and technology stakeholders.
Communicate complex configuration tradeoffs and product decisions clearly to executive leadership, clinical directors, and operational managers—driving alignment with data and analytic feedback.
Partner with data science, analytics, and AI teams to embed predictive models, automation triggers, and intelligent workflow recommendations into clinical products.
Collaborate with implementation and market teams to ensure product releases are effectively deployed, trained, and adopted across all operating states.
Identify and champion opportunities to leverage AI, machine learning, and robotic process automation to reduce administrative burden, accelerate clinical decisioning, and improve accuracy.
Partner with engineering to build AI-enabled workflows—including automated letter generation, intelligent case routing, clinical criteria auto-application, and ambient documentation integration.
Monitor AI/automation adoption metrics and continuously iterate on product design to maximize ROI and clinician trust.