Note: The job is a remote job and is open to candidates in USA. Humana is a healthcare company seeking a Lead Product Manager to drive the strategy, roadmap, and execution of products that modernize medical and electronic prior authorization experiences. The role leads cross-functional initiatives involving clinical, operational, technology, compliance, provider, and external partner stakeholders to deliver interoperable, efficient, scalable, and regulatory-compliant prior authorization solutions.
Responsibilities
- Define and execute the product vision, strategy, and roadmap for Prior Authorization and Electronic Prior Authorization capabilities
- Partner with business, clinical, operational, and technology stakeholders to identify opportunities to improve authorization workflows and customer experiences
- Translate complex clinical, operational, regulatory, and business requirements into product solutions and delivery plans
- Lead cross-functional efforts to define business requirements, user journeys, success metrics, and implementation strategies
- Collaborate with Product Owners, Engineering, and delivery teams to ensure successful execution of product initiatives
- Partner with Utilization Management, Provider, and Operations teams to drive process simplification, automation, and operational efficiency
- Build and maintain relationships with EMR/EHR vendors, interoperability partners, industry organizations, and external stakeholders
- Monitor CMS regulations, interoperability requirements, and industry trends to ensure product strategies remain compliant and forward-looking
- Establish and track product performance metrics related to provider experience, operational efficiency, adoption, compliance, and business outcomes
- Communicate product strategy, roadmap priorities, risks, and value realization to senior leadership and executive stakeholders
- Drive continuous improvement initiatives that enhance transparency, reduce administrative burden, and improve authorization experiences for providers and members
Skills
- * Bachelor's degree or equivalent experience
- * 8+ years of Product Management, Healthcare Technology, Clinical Operations, Utilization Management, or related experience
- * Demonstrated expertise in Medical Prior Authorization and/or Electronic Prior Authorization (ePA) workflows
- * Strong understanding of healthcare payer operations, utilization management processes, and clinical review workflows
- * Experience interpreting and implementing CMS regulations, healthcare interoperability requirements, and regulatory-driven product capabilities
- * Proven experience developing product strategies, product visions, and roadmaps while delivering measurable business outcomes
- * Experience leading complex cross-functional initiatives involving clinical, operational, technology, compliance, and business stakeholders
- * Demonstrated ability to gather, prioritize, and translate business and regulatory requirements into actionable product solutions
- * Strong stakeholder management, communication, and executive presentation skills
- * Ability to influence and drive alignment across highly matrixed organizations
- * Strong analytical, problem-solving, and decision-making capabilities
- * Proven ability to manage multiple priorities and drive execution in complex environments
- * Experience leading Prior Authorization modernization, automation, or digital transformation initiatives
- * Experience with healthcare interoperability standards and technologies, including FHIR, APIs, HL7, and related healthcare data exchange frameworks
- * Experience supporting CMS interoperability initiatives and regulatory mandates
- * Knowledge of provider workflow integration and provider-facing healthcare technology solutions
- * Experience partnering with industry organizations, clearinghouses, or interoperability vendors
- * Experience driving organizational change and adoption of healthcare technology solutions
- * MBA, MHA, RN, PharmD, or other relevant advanced degree
Benefits
- This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
- Remote position
- Medical, dental and vision benefits
- 401(k) retirement savings plan
- Time off, including paid time off, company and personal holidays, paid parental and caregiver leave
- Short-term and long-term disability
- Life insurance
Company Overview
Company H1B Sponsorship