We are seeking an experienced Product Owner with strong expertise in Provider Data Management (PDM), Provider Lifecycle Management (PLM), and Healthcare Capitation to lead Agile product initiatives within a Healthcare Payer / Health Plan environment.
The ideal candidate will have hands-on experience managing provider-focused products and processes, including provider onboarding, enrollment, credentialing, contracting, maintenance, termination, provider data quality, network management, capitation payments, reconciliation, and disbursement.
Key Responsibilities
- Own and prioritize product backlogs for Provider Data Management (PDM), Provider Lifecycle Management (PLM), and Healthcare Capitation.
- Define and maintain Epics, User Stories, Acceptance Criteria, and Product Requirements.
- Manage provider lifecycle processes including:
- Provider onboarding
- Provider enrollment
- Credentialing
- Contracting
- Provider maintenance
- Provider termination
- Drive Provider Data Management, data quality, and provider network initiatives.
- Support provider assignments, capitation payments, reconciliation, and disbursement processes.
- Collaborate with Provider Network, Finance, Actuarial, Operations, Business, and Engineering teams.
- Lead Sprint Planning, Backlog Refinement, Sprint Reviews, UAT, and product demonstrations.
- Manage defects, production validation, releases, risks, dependencies, and production sign-off.
- Ensure product processes align with CMS, Medicare/Medicaid, HIPAA, and provider contract requirements.
- Define and track KPIs related to:
- Provider data quality
- Provider lifecycle processing
- Payment accuracy
- Capitation reconciliation
- Provider network operations
Required Qualifications
- 5+ years of experience as a Product Owner, Product Manager, or Business Analyst in Agile environments.
- Strong experience in Healthcare Payer / Health Plan / Managed Care environments.
- Strong hands-on experience with Provider Data Management (PDM).
- Strong experience with Provider Lifecycle Management (PLM).
- Strong experience with Healthcare Capitation.
- Experience with Provider Network Management.
- Experience with Provider Enrollment and Credentialing.
- Experience with Provider Contracting.
- Strong understanding of:
- Product Backlog Management
- Epics
- User Stories
- Acceptance Criteria
- Requirements Management
- UAT
- Defect Management
- Production Validation / Sign-off
- Experience with Agile / Scrum / SAFe methodologies.
- Experience with Jira and Confluence.
- SQL experience is preferred.
Preferred Healthcare Domain Experience
Candidates with experience in the following areas are highly preferred:
- Healthcare Payer
- Health Plans
- Managed Care
- Provider Networks
- Provider Data
- Provider Lifecycle
- Provider Enrollment
- Credentialing
- Provider Contracting
- Capitation
- Provider Payment
- Capitation Reconciliation
- Medicare / Medicaid
- CMS
- HIPAA
Primary Skills
Product Owner | Provider Data Management (PDM) | Provider Lifecycle Management (PLM) | Healthcare Capitation | Provider Network Management | Healthcare Payer | Managed Care | Provider Enrollment | Credentialing | Agile | Scrum | SAFe | Jira | Confluence
Work Authorization
STRICT W2 ONLY
No C2C | No C2H | No OPT/F1 | No Third-Party Vendors
Candidates must be able to work directly on W2
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