Product Manager, Utilization Management (Remote)

At Availity, we're not just another Healthcare Technology company; we're pioneers reshaping the future of healthcare! With our headquarters in vibrant Jacksonville, FL, and an exciting office in Bangalore, India, along with an exceptional remote workforce across the United States, we're a global team united by a powerful mission. 

We're on a mission to bring the focus back to what truly matters – patient care. As the leading healthcare engagement platform, we're the heartbeat of an industry that impacts millions. With over 2 million providers connected to health plans, and processing over 12 billion transactions annually, our influence is continually expanding. 

Join our energetic, dynamic, and forward-thinking team where your ideas are celebrated, innovation is encouraged, and every contribution counts. We're transforming the healthcare landscape, solving communication challenges, and creating connections that empower the nation's premier healthcare ecosystem. 

We are seeking a Product Manager with expertise in Utilization Management (UM) and healthcare analytics, particularly outcome & value reporting. This role will focus on developing and enhancing UM solutions that streamline prior authorizations, medical necessity reviews, and payer-provider workflows while ensuring compliance with regulatory guidelines. The ideal candidate will bridge the gap between business, clinical, and technical teams to optimize utilization management processes and reporting capabilities. 

Sponsorship, in any form, is not available for this position. 

Why you want to work on this team: 

• You will have the opportunity to work on a cutting-edge solution that has the potential to reshape the way utilization management processes are handled in the industry. 

• Utilization Management is a hot topic in the healthcare industry and Availity is well positioned as a bridge between payers and providers to make the process better for both parties. 

• The culture on the bullet train is one of disruption, accountability, and doing the right thing.  You can wake up every day know that if you’re anchored to those things you will find purpose in your work.

To be qualified for this position you: 

• Utilization management operations experience required, clinical background preferred but not required if UM background is strong .

• Strong understanding of prior authorizations, medical necessity reviews, and payer policies. 

• Hands-on experience with Tableau or other tools for reporting, data visualization, and healthcare analytics. 

• Knowledge of EHRs, claims processing systems, and utilization management platforms.

• Business acumen: ability to materially contribute to a business case, evaluate feasibility & scalability, ability to assess and drive ROI, background in contracting

• Experience with AI-driven UM solutions and automation technologies. 

• Understanding of utilization metrics, value-based care models and population health analytics. 

• Understanding of industry and regulatory requirements 

• Ability to drive work with limited oversight 

• Desire to work in a fast-paced environment, with multiple competing priorities 

• Knowledge of coding and payment accuracy is nice to have 

• Strong written and verbal skills 

• Organized and detail oriented 

• Collaborative and creative 

You will set yourself apart with: 

• Familiarity with HL7, FHIR, and healthcare interoperability standards. 

• Proficiency in or willingness to learn Agile methodologies, JIRA, Confluence, and roadmapping tools. 

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You will be: 

• Revamping standard client reporting package; be business SME for data team to drive clarity in reporting needs 

• Building out of network performance reporting 

• Building out product performance reporting, including:  Specific client views (foundation for ROI and gainshare) AND Overall product performance 

• Serving as SME for UM benchmarking for client specific opportunity analysis and client reporting against metrics 

• Building  business requirements for various product enhancements 

• Prioritizing  additional product features to drive client adoption and speed to market 

• Tactical integration for business partners and collaborations, including integrated product development with Payment Accuracy Product Team 

• Managing pilot oversight to include: Working with pilot partners to drive business requirements, Creating and monitoring KPI/OKR’s, GTM planning, Scaling 

• Supporting sales, marketing and client success teams by providing product demos, training and analytics driven insights 

• Working with the delivery team after contract signature 

• Liaising to clinical team for CPT and Medical policy questions 

• Acting as the workflow SME 

• Prioritizing product feature build based on industry trends, client feedback, speed to value and in consideration of overall product roadmap 

Availity culture and benefits:  

• Availity is a certified “Great Place to Work”! Culture is important to us and there are many ways for you to make your mark here! 

• We have several Diversity & Inclusion teams, a Young Professionals Group, a She Can Code IT group for women in tech, and various ways to engage with fellow Availity associates.  

• Availity is a culture of continuous learning. We have many resources and experts in our tech stack and in our industry that can help get you there too! 

• Don’t feel like wearing business attire? Cool, you can wear jeans – we are a casual place. 

• We offer a competitive salary, bonus structure, generous HSA company contribution, healthcare, vision, dental benefits and a 401k match program that you can take advantage of on day one!  

• We offer unlimited PTO for salaried associates + 9 paid holidays. Hourly associates start at 19 days of PTO and go up from there with all the same holiday benefits.  

• Interested in wellness? We allow our associates to reimburse up to $250/year for gym memberships, participation in racing events, weight management programs, etc. 

• Interested in furthering your education? We offer education reimbursement! 

• Availity offers Paid Parental Leave for both moms and dads, both birth parents and adoptive parents.  

• Want to work for an organization that gives back to the community? You’re at the right place! Availity partners with various organizations, both locally and nationally, to raise awareness, funds and morale as our staff members volunteer their time and funds to engage the organizations campaign. 

Next steps:  

After you apply, you will receive text/email messages thanking you for applying and then you will continue to receive more text/email messages alerting you as to where you are in the recruitment process.  

Interview process:   

• Recruiter Resume Review

• Manager Resume Review

• Manager Video Interview

• Panel Video Interview

• Final Video Interview with Manager's Manager