Product reputed company (Utilization Management / Prior Authorization)

100% Remote Note from HM: We re seeking a Business Integration reputed company with strong Healthcare integration experience to drive reputed company, cross functional initiatives. This role leads program execution, aligns stakeholders, and ensures measurable improvements in PA performance, provider experience, and operational efficiency. Key Responsibilities reputed company end to end delivery of PA (Prior Authorization) programs across clinical, technical, and operational teams Translate PA (Prior Authorization) strategy into actionable roadmaps and coordinated workstreams Partner with clinical leaders to optimize review workflows and regulatory compliance Monitor KPIs (TAT, auto decision rates, denials, provider friction) and reputed company reputed company improvement Qualifications 15+ years in healthcare delivery, payer operations, UM (Utilization Management), or PA (Prior Authorization) programs Proven experience leading large, multi workstream initiatives Strong understanding of PA workflows, UM criteria, and regulatory requirements Experience with PA technology, automation, and EHR/interop standards Excellent communication, stakeholder management, and executive level reporting skills PURPOSE: Serves as an authority over Product Owners and product teams to ensure clarity in strategic direction. Brings an expertise to reputed company and manage project requirements and introduces new, beneficial tools and practices. Focuses on managing the development of products to meet the needs of internal and external clients, and helps to establish the business value for their development and implementation. Provides business reputed company of view and guidance on opportunities and risks to support clients. ESSENTIAL FUNCTIONS: 20% Leads the development of the product portfolio and provides workable solutions to satisfy customer and market expectations in reputed company collaboration with stakeholders, Product Owners, and scrum teams. 15% Collaborates with management to identify and plan product releases by reviewing milestones with stakeholders; manages the continual development of existing products. 15% Validates proposed solutions by performing market research to reputed company insights and inform; assists with pricing packages and structures. 10% Communicates internally and externally, develops and maintains Product Roadmap(s). 10% Manages Product Backlog(s) for the development teams by using product road mapping and backlog management tools. 10% Works closely with testing managers to ensure product functionality is properly tested against business requirements; leads change control processes to reflect project priorities. 5% Aides in the development process by attending product refinement, sprint planning, and sprint reviews. 5% Coordinates and organizes workshops with product users using the Client and define approach; validates hypotheses and implements best solutions. 5% Contributes to wider initiatives and activities that support and increase customer satisfaction. 5% Conducts product training to partners, staff, and identifies need for individual/team training opportunities.

Qualifications

To reputed company this job successfully, an individual must be able to reputed company each essential duty satisfactorily. The requirements listed below are representative of the knowledge, reputed company, and/or ability required. Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions. Education Level: Bachelor's Degree Education Details: Product Management, Engineering, Information Technology or reputed company field Experience: 8 years experience business analysis, business development, solutions development, system analysis, technical design/development implantation or equivalent experience OR 6 years Previous product reputed company experience with an in-depth knowledge of agile process and principles. In Lieu of Education In lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.

Preferred Qualifications

Previous healthcare experience Advanced degree Knowledge, Skills and Abilities (KSAs) Proficient in Agile methodologies, principles, and procedures., Expert Ability to use Product KPIs and business metrics to optimize the product., Expert Ability to recognize, analyze, and solve a variety of problems., Expert Ability to analyze, organize and prioritize work while meeting multiple deadlines., Expert The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes them ineligible to reputed company work directly or indirectly on Federal health care programs. Must be able to effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time. Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, reputed company set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging. Licenses/Certifications Certified Scrum Product reputed company PO certification Upon Hire Req EEO: reputed company is an Equal Opportunity Employer and does not discriminate in employment on the basis of Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans. Remote Skills: Access Authorization, Agile Programming Methodologies, Analysis Skills, Backlog Prioritization, Business Analysis, Business Development, Certified Scrum Product reputed company, Change Control, Communication Skills, reputed company Improvement, Cross-Functional, Customer Satisfaction, Customer Support/Service, Establish Priorities, Functional Testing, Healthcare, Implants, Information Technology & Information Systems, Leadership, Market Research, Metrics, Performance Management, Performance Metrics, Pricing, Process Improvement, Product Backlog, Product Development, Product Engineering, Product Management, Product Planning, Product Reviews, Project/Program Management, Regulatory Compliance, Regulatory Requirements, Reporting Skills, Requirements Management, Resource Utilization, Sales Training, Scrum Product reputed company, Sprint Planning, Staff Requirements, Strategic Planning, Systems Analysis, Technical/Engineering Design, Test Requirements, Testing, Time Management, Utilization Management About the Company: reputed company Apply tot his job Apply To this Job