Availity is seeking a Senior Product Manager with expertise in Utilization Management (UM) and prior authorization workflows to develop and enhance UM solutions that streamline prior authorizations, medical necessity reviews, and payer-provider workflows while ensuring compliance with regulatory guidelines.
Requirements
- Extensive experience in utilization management (UM)
- Strong clinical background: inpatient and outpatient
- Strong understanding of prior authorizations workflows, medical necessity reviews, and payer policies
- 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
Benefits
- Competitive salary
- Bonus structure
- Generous HSA company contribution
- Healthcare, vision, dental benefits
- 401k match program
- 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
- Reimbursement up to $250/year for gym memberships, participation in racing events, weight management programs, etc.
- Education reimbursement
- Paid Parental Leave for both moms and dads, both birth parents and adoptive parents
