Product Manager, Utilization Management

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