Pay Range:
$102,300.00 - $163,700.00
Please email if you are a candidate seeking a reasonable accommodation for the application and/or interview process.
Why this job matters:
Technically proficient Product Manager to oversee the day-to-day implementation and enhancement of our clinical integration and interoperability capabilities. This role will be responsible for managing implementation CMS-0057 compliance initiatives, Azure-based FHIR data ingestion pipeline, and bi-directional integration with EHR systems. The Product Manager will work closely with engineering, clinical, compliance, and external partners to deliver scalable, standards-based healthcare interoperability solutions.
What you will do:
- Drive the Clinical and Interoperability pod strategy and execution, focusing on compliance, scalability, and provider impact.
- Lead implementation of CMS-0057 including Provider Access APIs, Prior Authorization workflows (CRD, DTR, PAS), and Payer-to-Payer Data Exchange.
- Oversee ingestion of clinical data using FHIR APIs via Azure Health Data Services, Azure Functions (Node.js and C#), and Azure Data Factory.
- Manage bi-directional EHR integration efforts using FHIR, HL7v2, and other healthcare data standards.
- Ensure all interoperability components align with Azure-native architecture and HIPAA compliance requirements.
- Work with internal Data Governance teams to support data lineage, metadata, and data quality initiatives.
- Translate clinical and technical requirements into clear product specifications for development teams.
- Collaborate with EHR vendors and provider partners to streamline data exchange and onboarding.
- Collaborate with RISK Adjustment Team and Quality Gap stakeholders to ensure FHIR clinical data is flowing as expected and is being harnessed for the appropriate inputs around HCC risk score and care gaps
- Maintain ,build processes & Control around existing EMR eco systems and govern accordingly
- Engage stakeholders across payer, provider, and technical teams to drive adoption and usage.
- Stay informed on regulatory changes, FHIR enhancements, and interoperability trends like TEFCA and USCDI+.
What you need to succeed:
- 5+ years of product management experience in healthcare, health IT, or payer systems.
- Proven experience with CMS-0057, Da Vinci Implementation Guides (PAS, CRD, DTR), and healthcare compliance.
- Strong technical understanding of FHIR, HL7, USCDI, CCDA, and clinical data ingestion pipelines.
- Experience with Azure Health Data Services, Azure Functions (Node.js and C#), and Azure Data Factory.
- Demonstrated background in integrating with EHR systems
- Excellent communication and leadership skills across technical and clinical audiences.
- Ability to manage agile teams, prioritize backlogs, and deliver outcomes in cross-functional settings.
The extras:
- Experience with payer-provider interoperability platforms, TEFCA, or care coordination tools.
- Knowledge of value-based care, risk adjustment (HCC coding), and HEDIS/STAR measure implications.
Location:
BCBSRI is headquartered in downtown Providence, conveniently located near the train station and bus terminal. We actively support associate well-being and work/life balance and offer the following schedules, based on role:
- In-office: onsite 5 days per week
- Hybrid: onsite 2-4 days per week
- Remote: onsite 0-1 days per week. Permitted to reside in the following states, pending approval from the Human Resources Department: Arizona, Connecticut, Florida, Georgia, Louisiana, Massachusetts, North Carolina, Oklahoma, Rhode Island, South Carolina, Texas, Virginia
