Note: The job is a remote job and is open to candidates in USA. AmeriHealth Caritas is a mission-driven health care organization providing managed care and health care solutions to Medicaid populations. The Product Manager, Clinical Informatics leads the strategy, design, delivery, and adoption of clinical technology products supporting utilization management, care management, quality operations, interoperability, and member engagement. The role owns product roadmaps, ensures regulatory compliance, coordinates cross-functional teams, and advances AI-enabled workflows and automation.
Responsibilities
- Own the clinical product vision, roadmap, and prioritization for assigned domain(s)—UM, CM, quality, and/or interoperability—ensuring alignment with enterprise business plan objectives, regulatory timelines, and market expansion strategy
- Translate business strategy into a scalable product backlog with clearly defined epics, features, and user stories using Agile/iterative delivery practices
- Conduct competitive landscape analysis and market scanning to inform product positioning, identify whitespace opportunities, and benchmark against industry-leading Medicaid MCO capabilities
- Define and track KPIs tied to product performance—including cycle time reduction, auto-adjudication rates, clinical throughput, regulatory compliance, and user adoption, using insights to drive continuous improvement
- Drive product alignment with CMS Interoperability and Prior Authorization Final Rule, TEFCA, FHIR-based API requirements, and state-specific Medicaid regulatory mandates
- Collaborate with data engineering and integration teams to ensure clinical data exchange (HL7, FHIR, X12, RAPS/EDPS) meets performance, security, and compliance standards
- Manage product requirements for HEDIS supplemental data capture, NCQA accreditation support, and quality measure reporting
- Support delegation oversight by ensuring vendor-facing products and integrations meet contractual and regulatory requirements
- Facilitate governance forums, cross-functional design sessions, and sprint ceremonies to align product delivery with business, clinical, and technology stakeholders
- Communicate complex configuration tradeoffs and product decisions clearly to executive leadership, clinical directors, and operational managers—driving alignment with data and analytic feedback
- Partner with data science, analytics, and AI teams to embed predictive models, automation triggers, and intelligent workflow recommendations into clinical products
- Collaborate with implementation and market teams to ensure product releases are effectively deployed, trained, and adopted across all operating states
- Identify and champion opportunities to leverage AI, machine learning, and robotic process automation to reduce administrative burden, accelerate clinical decisioning, and improve accuracy
- Partner with engineering to build AI-enabled workflows—including automated letter generation, intelligent case routing, clinical criteria auto-application, and ambient documentation integration
- Monitor AI/automation adoption metrics and continuously iterate on product design to maximize ROI and clinician trust
Skills
- Bachelor's Degree required
- Minimum of 3 years of clinical product management experience for a payor
- Experience with clinical workflows
- Project management experience using Agile methodology
- Experience researching competitors and market trends to guide product strategy, find open gaps, and measure performance against best practices within the industry
- Experience defining and tracking KPIs tied to product performance
Benefits
- Flexible work solutions including remote options
- Hybrid work schedules
- Paid time off including holidays and volunteer events
- Health insurance coverage for you and your dependents on Day 1
- 401(k)
- Tuition reimbursement
- Remote role
Company Overview