Product Manager

SOLVENTUM•New York, NY

3d•$143,200 - $196,900•Remote

About The Position

Solventum Health Information Systems (Solventum HIS) is a leader in helping commercial and government payers control costs and increase access to quality care using industry standards and Solventum clinically based methodologies developed and refined over more than 40 years. These reliable metrics help commercial payers, as well as most state Medicaid programs, analyze and track performance, reduce inefficiencies, and drive better outcomes. The Product Manager demonstrates cross-functional leadership to develop and define strategy and identify a product vision for health plan solutions that focuses on risk adjustment optimization, quality, and financial integrity. The person in this position will collect voice of customer and analyze competitive landscapes to ensure that Solventum solutions meet the most critical customer needs. This highly visible role will provide strategic leadership to ensure Solventum delivers solutions to health plans that include the integration of medical and pharmacy claims with clinical/patient chart data. The person hired for the position of Product Manager will join a team focused on delivering provider, payer and business partner solutions for Solventum and other methodologies used for payment, quality, and performance management by government and commercial payer programs. Solventum patient classification methodologies help health care payers and providers understand the value of population health and patient care by providing insights into patient mix, risk adjustment, expected reimbursement and quality outcomes. Rapid data enrichment delivered through a business intelligence platform, as well as structured extracts, empowers organizations to act sooner to drive change. This person hired for this position must be a team player who wants to be involved in healthcare transformation and works well in a collaborative and multi-faceted environment. As a Product Manager, you will focus on developing solutions that enhance the accuracy of member risk scores (RAF scores) and improve quality metrics (such as HEDIS/Star Ratings) by leveraging data derived from medical claims, pharmacy data, and clinical charts.

Requirements

Bachelor’s Degree or higher from an accredited university AND a minimum of Seven (7) years of experience in Healthcare Information Technology or Product Development. OR High School Diploma/GED AND a minimum of 14+ years of experience in Healthcare Information Technology or Product Development.
Seven (7) years of experience working in the healthcare industry, preferably with experience across commercial, Medicaid and/or Medicare health plans, and healthcare providers.
Seven (7) years of experience in product management, preferably with risk adjustment or population health technology.
Must be legally authorized to work in country of employment without sponsorship for employment visa status (e.g., H1B status).

Nice To Haves

Strong knowledge of clinical data, medical and pharmacy claims, billing, member eligibility, and quality measures.
Strong understanding of Medicare Advantage, ACA, or Medicaid risk adjustment models.
Ability to work with large datasets containing claims and clinical data, with experience in medical coding and clinical workflows.
Experience collaborating with engineering teams on healthcare platforms.
Ability to analyze market trends and regulatory changes to drive product strategy.
Familiarity with data warehousing and business intelligence terminology.
Experience working within an agile development organization.
Understanding of HCC, MS-DRG and APC, as well as proprietary Solventum methodologies, including APR DRG, EAPG, CRG, PPR, PPC, AM-PPC, PFP, and PFE.
Demonstrate urgency, accountability, and results orientation, applying a growth mindset to support initiatives related to healthcare payment innovation, patient safety, operational efficiency, quality of care, and value-based care.

Responsibilities

Serving as the intersection between business, technology, sales, service, marketing, and the user experience
Owning the product strategy, roadmap and feature definition of a product line focused on core risk adjustment capabilities using clinical and claims data
Maximizing value from disparate data sources by integrating various data types (medical claims, pharmacy data, clinical charts, etc.) to identify and close documentation gaps
Driving incorporation of AI-driven or rules-based algorithms to identify potential undocumented conditions and streamline coding workflows
Utilizing clinical data to validate diagnoses, enhance coding accuracy, and support retrospective/prospective chart reviews to ensure high quality, compliant documentation
Complying with corporate policies, procedures and security standards while performing assigned duties.