Note: The job is a remote job and is open to candidates in USA. Blue Cross & Blue Shield of Rhode Island is seeking a Senior IT Product Manager to oversee implementation and enhancement of clinical integration and interoperability capabilities. The role leads CMS-0057 compliance initiatives, FHIR data ingestion and EHR integration, collaborating with engineering, clinical, compliance, and external partners to deliver scalable healthcare interoperability solutions.
Responsibilities
- Drive the Clinical and Interoperability pod strategy and execution, focusing on compliance, scalability, and provider impact
- Lead implementation of CMS-0057 including Provider Access APIs, Prior Authorization workflows (CRD, DTR, PAS), and Payer-to-Payer Data Exchange
- Oversee ingestion of clinical data using FHIR APIs via Azure Health Data Services, Azure Functions (Node.js and C#), and Azure Data Factory
- Manage bi-directional EHR integration efforts using FHIR, HL7v2, and other healthcare data standards
- Ensure all interoperability components align with Azure-native architecture and HIPAA compliance requirements
- Work with internal Data Governance teams to support data lineage, metadata, and data quality initiatives
- Translate clinical and technical requirements into clear product specifications for development teams
- Collaborate with EHR vendors and provider partners to streamline data exchange and onboarding
- Collaborate with RISK Adjustment Team and Quality Gap stakeholders to ensure FHIR clinical data is flowing as expected and is being harnessed for the appropriate inputs around HCC risk score and care gaps
- Maintain ,build processes & Control around existing EMR eco systems and govern accordingly
- Engage stakeholders across payer, provider, and technical teams to drive adoption and usage
- Stay informed on regulatory changes, FHIR enhancements, and interoperability trends like TEFCA and USCDI+
Skills
- 5+ years of product management experience in healthcare, health IT, or payer systems
- Proven experience with CMS-0057, Da Vinci Implementation Guides (PAS, CRD, DTR), and healthcare compliance
- Strong technical understanding of FHIR, HL7, USCDI, CCDA, and clinical data ingestion pipelines
- Experience with Azure Health Data Services, Azure Functions (Node.js and C#), and Azure Data Factory
- Demonstrated background in integrating with EHR systems
- Excellent communication and leadership skills across technical and clinical audiences
- Ability to manage agile teams, prioritize backlogs, and deliver outcomes in cross-functional settings
- Experience with payer-provider interoperability platforms, TEFCA, or care coordination tools
- Knowledge of value-based care, risk adjustment (HCC coding), and HEDIS/STAR measure implications
Benefits
- Flexible work arrangements, including remote and hybrid opportunities. Hybrid schedules are onsite 2–4 days per week; remote schedules are onsite 0–1 days per week and permitted only in Arizona, Connecticut, Florida, Georgia, Louisiana, Massachusetts, North Carolina, Oklahoma, Rhode Island, South Carolina, Texas, or Virginia, pending Human Resources approval.
- Paid time off.
- Tuition reimbursement.
- Student-loan repayment assistance.
- Health, dental, and vision insurance.
- Programs supporting mental health and well-being.
- Bonuses.
- Investment plans.
- Additional paid time to volunteer.
Company Overview
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