Drive the functional and technical roadmap for Clinical Solutions, including Utilization, Care Management platforms, Clinical decision support systems, quality measures, and interoperability solutions leveraging Alignment’s proprietary AVA and Vendor platforms.
Ensure compliance with CMS, NCQA, HIPAA, and other regulatory requirements impacting clinical data and processes.
Anticipate regulatory and operational changes (e.g., CMS rule updates, encounter data submission requirements) and integrate them into the roadmap.
Lead the design, testing, and implementation of new features for Clinical solutions platforms.
Define and drive integration with Electronic Health Records (EHRs), Health Information Exchanges (HIEs), and other clinical data platforms via APIs, HL7, FHIR, and batch interfaces.
Partner with data engineering teams to design solutions that support risk adjustment, HEDIS/Stars quality reporting, care gap closure, and population health analytics.
Define and prioritize features for provider-facing tools such as prior authorization, utilization management, case management, and clinical documentation improvements.
Collaborate with clinicians, business stakeholders, and technology teams to translate clinical workflows and requirements into scalable technical solutions.
Requirements
5+ years of Product Management experience in healthcare technology, with a focus on clinical solutions.
Microsoft SQL (querying, optimization, reconciliation, audits)
ETL Tools such as Microsoft SSIS and Azure Data Factory
Cloud Platforms (Azure/AWS)
Experience integrating vendor solutions.
Strong knowledge of clinical workflows, care management, utilization management, and quality reporting.
Strong analytical, problem-solving, and communication skills with the ability to translate technical details into business outcomes.
Bachelor's degree in Healthcare Information Systems, Computer Science or related field; advanced degree or clinical background (RN, PharmD, MPH, etc.) strongly preferred. MBA or advanced degree preferred.
Benefits
Health insurance
401(k) matching
Flexible work arrangements
Paid time off
Professional development opportunities
Applicant Tracking System Keywords
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