Availity · 1 week ago
Product Manager, Prior Authorizations
United States
Full-time
Remote
Mid, Senior Level
5+ years expAvaility is a leading healthcare engagement platform delivering revenue cycle and related business solutions. They are seeking a Product Manager with expertise in prior authorization workflows to implement interoperable solutions that streamline healthcare processes while ensuring compliance with regulatory guidelines.
FitnessHealth CareHospital
No H1B
Responsibilities
Define and communicate a clear product roadmap aligned with CMS requirements, industry trends, and organizational goals
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
Collaborate with engineering, data, and delivery teams to ensure timely, compliant, and scalable product releases
Serve as the subject matter expert on prior authorization workflows and FHIR standards; provide guidance internally and externally
Monitor CMS mandates, industry trends, and client feedback to inform product decisions and prioritize features
Lead pilots, define KPIs/OKRs, and drive successful go-to-market strategies
Define product performance metrics and partner with data teams to deliver actionable insights for ROI and gainshare
Align executives, clients, and internal teams on product vision, progress, and outcomes
Qualification
Required
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
Preferred
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
Benefits
Competitive salary
Bonus structure
Generous HSA company contribution
Healthcare
Vision
Dental benefits
401k match program
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
Reimburse 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
Company
Availity
Availity offers a free access to real-time information and instant responses for healthcare professionals.
1001-5000 employees
Funding
Current Stage
Late StageTotal Funding
$200MKey Investors
Novo HoldingsFrancisco Partners
2021-07-07Secondary Market
2017-10-19Private Equity· $200M
Leadership Team
Russ Thomas
Chief Executive Officer
Frank Petito
Chief Financial Officer
Recent News
2026-01-16
2026-01-16
Company data provided by crunchbase