Lead Product Manager - Interoperability Prior Authorizations

About this role

Become a part of our caring community   Humana is seeking a Lead Product Manager - Interoperability Prior Authorization to drive the strategy, roadmap, and execution of products that modernize medical and electronic prior authorization experiences. This role will lead initiatives that improve provider and member experiences, streamline healthcare operations, and support compliance with evolving interoperability and regulatory requirements. The ideal candidate brings a strong understanding of healthcare payer operations, prior authorization workflows, clinical processes, and CMS regulations, combined with proven experience developing product strategies and leading complex cross-functional initiatives. This individual will play a key role in advancing Humana's vision for efficient, scalable, and interoperable prior authorization solutions.

The Lead Product Manager is responsible for defining and delivering Prior Authorization and Electronic Prior Authorization (ePA) capabilities that improve information exchange, operational efficiency, regulatory compliance, and customer experience. This role works closely with Clinical, Utilization Management, Operations, Technology, Compliance, Provider, and external partner organizations to identify opportunities, prioritize investments, and deliver innovative solutions. Responsibilities include the following: • 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.

Use your skills to make an impact   Required Qualifications • 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.

Preferred Qualifications • 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.

Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.   Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.  

Scheduled Weekly Hours

40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic l

Similar jobs

• Lead Product Designer, Care Access Network — Zocdoc · New York, NY
• Lead Product Manager - Provider Direct Connect — Humana · Remote
• Lead Product Manager, Claims Automation — Sidecarhealth · Remote
• Principal Product Manager, Heathcare Technology — RELX (ElsevierJobs) · Home based-Washington DC | Home based-Georgia | Home based-Illinois
• Principal Product Manager, Heathcare Technology — RELX · Home based-Washington DC | Home based-Georgia | Home based-Illinois
• Lead Product Designer, Provider Experience — A Place for Mom · Remote
• Lead Product Manager — Creative Artists Agency (CAA) · Los Angeles, CA
• Lead Product Manager — Disney · Anaheim, CA | Orlando, FL