About this role
A Utilization Management (UM) Product Manager leads the strategy, development, and roadmap of software tools designed to optimize healthcare services, ensuring cost-effective, timely, and compliant patient care. They bridge clinical teams, technology, and operations by building features for prior authorization, clinical review workflows, and data analytics Key Responsibilities Product Strategy & Roadmap: Define the vision and roadmap for UM platforms, prioritizing features based on client feedback, industry trends (e.g., AI integration), and ROI. Workflow Design & Optimization: Act as a subject matter expert (SME) to design and configure clinical decision logic, coverage rules, and prior authorization workflows. Cross-Functional Leadership: Lead Agile development teams and collaborate with Clinical Policy, Engineering, Data, Compliance, and Sales teams. Data & Analytics: Develop performance reporting and analytics to evaluate UM program effectiveness and identify improvement opportunities. Compliance & Standards: Ensure product adherence to NCQA, CMS guidelines, and state regulations. Key Requirements Experience: 3+ years in healthcare technology, managed care, or clinical settings. Domain Knowledge: Strong understanding of utilization management principles, clinical coding (CPT/ICD-10), and medical policy. Technical Skills: Experience with SaaS products, AI/automation tools, and data analysis platforms. Education: Bachelor’s degree in Healthcare Administration, Business, or related field; clinical background (e.g., RN) is often preferred. Skills: Excellent communication, stakeholder management, and ability to translate complex regulations into product requirements.