Product Manager, Utilization Management (Remote)

Availity delivers revenue cycle and related business solutions for health care professionals who want to build healthy, thriving organizations. Availity has the powerful tools, actionable insights and expansive network reach that medical businesses need to get an edge in an industry constantly redefined by change.

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 Senior Product Manager with expertise in Utilization Management (UM) and prior authorization workflows. 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 work that the team is doing is one of disruption, accountability, and doing the right thing which equates to meaningful work.

To be qualified for this position you have:

• Extensive experience in utilization management (UM). Candidates without UM experience would not be considered.

• Strong clinical background: inpatient and outpatient.

• Strong understanding of prior authorizations workflows, medical necessity reviews, and payer policies. This is required to be considered for the role.

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

• Business acumen: ability to 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. 

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

• Knowledge of regulatory and accreditation requirements.

• Ability to drive work with limited oversight.

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

You will set yourself apart with:

• Healthcare technology background. Product background highly preferred.

• Proficiency in analyzing data and finding actionable insights.

• Ability to manage ambiguity in a fast-paced environment.

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

• Familiarity with coding (CPT codes) and payment accuracy.

What you will be doing:

• Building business requirements for various product enhancements. 

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

• Managing pilot oversight to include working with pilot partners to drive business requirements, creating and monitoring KPI/OKR’s, GTM planning, scaling, etc. 

• Liaising to clinical team for CPT and Medical policy questions.

• Acting as the Utilization Management workflow SME.

• Prioritizing product feature build based on industry trends, client feedback, speed to value while balancing the overall product roadmap.

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

• Building out product performance reporting, including specific client views (foundation for ROI and gainshare) and overall product performance. 

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

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

• Working with the delivery team after contract signature.

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 Recorded Video Pre-Screen

• Video Interview with Hiring Manager

• Panel Video Interview

• Final Video with Hiring Manager

Video Camera Usage:

Availity fosters a collaborative and open culture where communication and engagement are central to our success.  As a remote first company, we are also camera-first and provide all associates with camera/video capability to simulate the office environment. If you are not able to use your camera for all virtual meetings, you should not apply for this role.

Having cameras on helps create a more connected, interactive, and productive environment, allowing teams to communicate more effectively and build stronger working relationships.  The usage of cameras also enhances security and protects sensitive company information. Video participation is required to ensure that only authorized personnel are present in meetings and to prevent unauthorized access, data breaches, preventing social engineering, or the sharing of confidential information with non-participants.

Disclaimers:

Availity is an equal opportunity employer and makes decisions in employment matters without regard to race, religious creed, color, age, sex, sexual orientation, gender identity, gender expression, genetic information, national origin, religion, marital status, medical condition, disability, military service, pregnancy, childbirth and related medical conditions, or any other classification protected by federal, state, and local laws and ordinances.

Availity is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

NOTICE: Federal law requires all employers to verify the identity and employment eligibility of all persons hired to work in the United States. When required by state law or federal regulation, Availity uses I-9, Employment Eligibility Verification in conjunction with E-Verify to determine employment eligibility. Learn more about E-Verify at http://www.dhs.gov/e-verify.

Click the links below to view Federal Employment Notices.

Family & Medical Leave Act  Equal Employment Law Poster  Pay Transparency  Employee Polygraph Protection Act  IER Right to Work Poster  Important Notice about Employee Rights to Organize and Bargain Collectively with Their Employers