About The Position
Availity is seeking a Vice President of Product, Medical Cost Containment & Authorization to lead the strategy, execution, and scale of our Utilization Management (UM) product portfolio during a pivotal moment of industry transformation. This VP will own an end‑to‑end product suite that blends AI‑driven decisioning, healthcare interoperability, and deep UM expertise, with a mandate to modernize and disrupt how utilization management is delivered across the healthcare ecosystem. This is a high‑impact, executive‑level role for a product leader who thrives in ambiguity, can operate as a peer to senior executives, and has the confidence to lead through scale, complexity, and change. Sponsorship, in any form, is not available for this position.
Requirements
- Bachelor’s degree required; advanced degree (MBA, MHA, MPH, RN, MD) strongly preferred.
- 10+ years of experience in healthcare product management, medical management, or utilization management.
- 5+ years in a senior product leadership role.
- Deep expertise in prior authorization, utilization review, and medical cost containment strategies.
- Strong understanding of managed care, payer operations, and healthcare regulations.
- Experience working with clinical teams and medical policy development.
- Background in digital health, automation, or AI-enabled clinical workflows.
- Proven success launching complex, regulated healthcare products at scale.
- Strategic product leadership and executive-level communication.
- Ability to translate clinical and regulatory complexity into usable products.
- Strong analytical and financial acumen.
- Collaborative leadership across clinical, technical, and business teams.
- Comfort operating in highly regulated, fast-changing environments.
- Must be able to use camera for all virtual meetings.
Nice To Haves
- Proven track record in building AI products from incubation to scale
- Experience disrupting an established healthcare workflow
Responsibilities
- Product Strategy & Vision: Defining and owning the long-term product vision and roadmap for medical cost containment and authorization capabilities. Aligning product strategy with enterprise affordability, quality, and growth goals. Identifying market trends, regulatory changes, and competitive opportunities impacting utilization management and authorization.
- Product Development & Lifecycle Management: Leading the end-to-end product lifecycle from concept through launch, optimization, and sunset. Translating clinical, operational, and regulatory requirements into clear product requirements and prioritization. Partnering with engineering and data teams to deliver scalable, configurable authorization and cost containment solutions. Ensuring products support evidence-based medicine, medical policy, and evolving clinical guidelines.
- Medical Cost Containment & Authorization: Overseeing products supporting prior authorization, concurrent review, retrospective review, and specialty management. Driving innovation in automation, rules engines, AI-assisted review, and straight-through processing. Balancing cost containment objectives with access to care, provider experience, and member satisfaction.
- Cross-Functional Leadership: Collaborating with stakeholders across products to ensure integrity and regulatory adherence. Partnering with Leadership & Finance to quantify savings impact and ROI. Supporting Sales and Client Management with product positioning, differentiation, and client engagement.
- Governance, Compliance & Quality: Ensuring products comply with federal and state regulations (e.g., CMS, NCQA, URAC, state DOI requirements). Supporting audit readiness and accreditation standards related to utilization management. Establishing KPIs and governance models to monitor product performance, outcomes, and quality.
- Team Leadership: Building, mentoring, and leading high-performing product management teams. Fostering a culture of accountability, innovation, and continuous improvement.
Benefits
- Competitive salary
- Bonus structure
- Generous HSA company contribution
- Healthcare
- Vision
- Dental benefits
- 401k match program
- Unlimited PTO for salaried associates
- 9 paid holidays
- Reimbursement up to $250/year for gym memberships, participation in racing events, weight management programs, etc.
- Education reimbursement
- Paid Parental Leave for both moms and dads, both birth parents and adoptive parents.
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What This Job Offers
Job Type
Full-time
Career Level
Executive
