Lead Product Manager - Interoperability Prior Authorizations

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* 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…