Lead Product Manager - Interoperability Prior Authorizations

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 location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $126,300 - $173,700 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 08-23-2026 About us About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com. ​ Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.