Senior Product Manager - Value-Based Care & AI

Medisolv•Clarksville, MD

12h

About The Position

Medisolv partners with hospitals, health systems, ACOs, and payers to bring clarity to quality data, connecting clinical and claims information into a single, reliable view. More than 1,800 organizations and 130M+ patient records rely on Medisolv to measure, report, and improve performance across 500+ measures tied to CMS, The Joint Commission, and other programs. With support from Bessemer Venture Partners Forge, we’re continuing to grow our platform and expand our impact—investing in advanced analytics, AI, and new capabilities that help healthcare organizations stay ahead of change and improve outcomes with confidence. This role is for someone who knows the health insurance and VBC worlds inside out, understands the math behind CMS quality calculations, and is genuinely excited about putting autonomous AI agents to work on messy healthcare data.

Requirements

5+ years of product management experience handling health plan data and VBC provider quality metrics.
Deep understanding of risk adjustment, utilization management, and how risk-bearing entities operate.
Expertise in how CMS calculates MA Star Ratings, including cut points and the impact of triple-weighted measures.
Hands-on experience working with claims, eligibility, and enrollment datasets, and ability to map these back to quality performance.
Understanding of GenAI architectures, RAG, and agentic frameworks (like LangChain, AutoGen, or similar orchestration toolsets).
Comfortable talking to engineers about vector databases, APIs, and semantic data layers.
Understanding of how to build within HIPAA/HITRUST guidelines and ensure AI outputs are accurate, unbiased, and explainable.
Ability to take initiative and drive tasks from inception to completion.
Empathy for colleagues and ability to demonstrate and influence cross-functional collaboration.
Flexibility and adaptability to changing environments in a growth-stage company.
Intellectual curiosity and a love for figuring out how things work.
Resilience and optimism in the face of change.

Nice To Haves

A "Beyond-the-Dashboard" Mindset: Tired of building static BI tools; desire to build proactive software that thinks, adapts, and automates workflows rather than just reporting on them.

Responsibilities

Build a deep understanding of Medisolv’s data ecosystem and CMS measure logic (HEDIS, Pharmacy, CAHPS/HOS).
Align with engineering, AI, and clinical stakeholders on priorities and high-impact use cases.
Define initial AI agent architecture and guiding principles for HITL safety and compliance.
Design and prototype AI agents to identify care gaps and predict Star Rating risks.
Stand up the foundation of the payer data core from fragmented datasets.
Develop initial CMS measure calculation engines and pilot action-oriented workflows.
Deploy production-ready AI agents that connect insights directly to gap-closing actions.
Expand and stabilize the payer data core and measurement automation.
Implement orchestrated workflows and mature HITL guardrails.
Optimize AI performance with feedback loops and expand to more advanced use cases.
Mature the data platform into a scalable, real-time decisioning engine.
Drive measurable improvements in Star Ratings and value-based care outcomes.