Product Manager, Clinical & Authorization
RxSense
full-time
Posted on:
Location Type: Remote
Location: United States
Visit company websiteExplore more
Salary
💰 $100,000 - $149,000 per year
About the role
- The Product Manager – Clinical & Authorization Platforms owns the strategy, roadmap, and execution of RxSense’s clinical rules infrastructure and prior authorization capabilities.
- This role is responsible for the platform functionality that enables clients to configure, operationalize, and scale their clinical policies and utilization management programs.
- Ensure accurate implementation of client-defined clinical criteria into configurable system logic.
- Design scalable configuration models that support multiple enterprise clients without degrading performance.
- Maintain consistency between formulary integration, clinical edits, and authorization workflows.
- Lead the evolution of electronic PA submission, review, approval/denial, exception, and appeals processes.
- Define and monitor KPIs that measure workflow efficiency, automation, and rule effectiveness.
Requirements
- 4+ years of experience in a PBM, health plan, or healthcare technology environment with direct exposure to prior authorization and utilization management workflows.
- 4+ years working within agile product teams, healthcare operations, or related environments.
- Experience working with clinical rules engines, decision support systems, or authorization platforms.
- Strong understanding of how clinical criteria are operationalized within adjudication and workflow systems.
- Familiarity with ePA standards and healthcare interoperability (e.g., NCPDP SCRIPT, FHIR).
- Experience operating within agile product environments and managing roadmaps/backlogs in JIRA (or similar tools).
- Proven ability to communicate effectively across engineering, clinical, operational, and executive stakeholders.
- Strategic mindset with the ability to connect platform capabilities to client needs and business growth objectives.
Benefits
- RxSense believes that a diverse workforce is a more talented and productive workforce.
- We are an Equal Opportunity and Affirmative Action employer.
- Our recruitment process is free from discriminatory hiring practices.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
clinical rules infrastructureprior authorization capabilitiesutilization management programsconfiguration modelsworkflow efficiencyautomationrule effectivenessclinical rules enginesdecision support systemsePA standards
Soft Skills
communicationstrategic mindsetstakeholder management