Senior IT Product Manager

Blue Cross & Blue Shield of Rhode Island•Providence, RI

3d•$102,300 - $163,700

About The Position

The Senior IT Product Manager oversees the day-to-day implementation and enhancement of BCBSRI’s clinical integration and interoperability capabilities. The role manages CMS-0057 compliance initiatives, an Azure-based FHIR data ingestion pipeline, and bi-directional integration with EHR systems. It works with engineering, clinical, compliance, and external partners to deliver scalable, standards-based healthcare interoperability solutions.

Requirements

5+ years of product management experience in healthcare, health IT, or payer systems.
Proven experience with CMS-0057, Da Vinci Implementation Guides (PAS, CRD, DTR), and healthcare compliance.
Strong technical understanding of FHIR, HL7, USCDI, CCDA, and clinical data ingestion pipelines.
Experience with Azure Health Data Services, Azure Functions (Node.js and C#), and Azure Data Factory.
Demonstrated experience integrating with EHR systems.
Excellent communication and leadership skills across technical and clinical audiences.
Ability to manage agile teams, prioritize backlogs, and deliver outcomes in cross-functional settings.

Nice To Haves

Experience with payer-provider interoperability platforms, TEFCA, or care coordination tools.
Knowledge of value-based care, risk adjustment (HCC coding), and HEDIS/STAR measure implications.

Responsibilities

Drive the Clinical and Interoperability pod strategy and execution, focusing on compliance, scalability, and provider impact.
Lead implementation of CMS-0057, including Provider Access APIs, Prior Authorization workflows (CRD, DTR, PAS), and Payer-to-Payer Data Exchange.
Oversee clinical data ingestion using FHIR APIs through Azure Health Data Services, Azure Functions, and Azure Data Factory.
Manage bi-directional EHR integration efforts using FHIR, HL7v2, and other healthcare data standards.
Ensure interoperability components align with Azure-native architecture and HIPAA compliance requirements.
Work with Data Governance teams on data lineage, metadata, and data quality initiatives.
Translate clinical and technical requirements into product specifications for development teams.
Collaborate with EHR vendors and provider partners to streamline data exchange and onboarding.
Work with Risk Adjustment and Quality Gap stakeholders to ensure FHIR clinical data flows as expected and supports HCC risk scores and care gaps.
Maintain and build processes and controls around existing EMR ecosystems and govern them accordingly.
Engage payer, provider, and technical stakeholders to drive adoption and usage.
Stay informed about regulatory changes, FHIR enhancements, and interoperability trends such as TEFCA and USCDI+.