Product Manager, Prior Authorizations

Availity

1d•Remote

About The Position

Availity delivers revenue cycle and related business solutions for health care professionals who want to build healthy, thriving organizations. Availity has the powerful tools, actionable insights and expansive network reach that medical businesses need to get an edge in an industry constantly redefined by change. Availity delivers revenue cycle and related business solutions for health care professionals who want to build healthy, thriving organizations. Availity has the powerful tools, actionable insights and expansive network reach that medical businesses need to get an edge in an industry constantly redefined by change. At Availity, we're not just another Healthcare Technology company; we're pioneers reshaping the future of healthcare! With our headquarters in vibrant Jacksonville, FL, and an exciting office in Bangalore, India, along with an exceptional remote workforce across the United States, we're a global team united by a powerful mission. We're on a mission to bring the focus back to what truly matters - patient care. As the leading healthcare engagement platform, we're the heartbeat of an industry that impacts millions. With over 2 million providers connected to health plans, and processing over 12 billion transactions annually, our influence is continually expanding. Join our energetic, dynamic, and forward-thinking team where your ideas are celebrated, innovation is encouraged, and every contribution counts. We're transforming the healthcare landscape, solving communication challenges, and creating connections that empower the nation's premier healthcare ecosystem. 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.

Requirements

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.

Nice To Haves

Product background highly preferred.
Familiarity with Agile/Scrum, product management tools (Jira, Aha), and EHR systems.
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.

Responsibilities

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.

Benefits

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.

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