Product Manager Medical Management Platform

Job Title: Product Manager Medical Management Platform

Duration: Long-term

Location: Eagan, MN

Job Description:

Product Manager Medical Management Platform

Led the transformation of a next-generation Medical Management platform integrating Utilization Management (UM), Care Management (CM), and Member Appeals to improve operational efficiency and member outcomes.

Key Responsibilities

• Led business process transformation initiatives and future-state workflow design across UM, CM, and Appeals.
• Directed vendor evaluation, pricing negotiations, and SOW definition for the HealthEdge GuidingCare platform implementation.
• Facilitated cross-functional workshops to streamline operations, eliminate process gaps, and improve enterprise workflows.
• Designed the functional architecture supporting end-to-end intake and lifecycle management of authorizations, care management cases, and appeals across internal systems and third-party platforms.
• Integrated enterprise applications including Customer Service, Claims, Provider Portals, Health & Wellness, HRAs, SDoH, Availity, Itiliti, MCG, and related data sources.
• Implemented AI-driven capabilities to automate authorization decision support, care management identification, UM-to-CM handoffs, smart OCR fax intake, and Transitions of Care workflows.
• Collaborated with business, clinical, and technology stakeholders to deliver scalable, integrated healthcare solutions that improved operational efficiency and enhanced the member experience.