Senior Director of Product Management (Risk & Quality) - Payer

Quick Facts

• Own end-to-end product strategy, roadmap, and GTM execution for payer Risk & Quality solutions
• Lead multi-year vision across Risk Adjustment, RADV/Audit Readiness, and integrated Quality/HEDIS/Stars
• Drive AI-native product innovation and measurable compliance and revenue accuracy outcomes

Description

Reporting to executive leadership, you will hold end-to-end accountability for the product strategy and go-to-market execution across Risk Adjustment, RADV Audit Readiness, and Quality (HEDIS/Stars). You will translate complex regulatory requirements and risk-capture workflows into an AI-native platform that improves verifiable revenue accuracy, audit defensibility, and operational efficiency. You will partner with Engineering, Data Science, Clinical SMEs, and customer-facing teams to deliver outcome-based ROI metrics.

Responsibilities

• Own multi-year portfolio vision for Risk Adjustment (Prospective, Concurrent, Retrospective), RADV Audit Management, Risk Analytics, and integrated Quality/HEDIS products
• Build an AI-native roadmap using NLP, LLMs, and automated chart retrieval/coding engines to reduce manual touchpoints
• Stay ahead of CMS, HHS, and state regulatory changes to ensure continuous product compliance
• Align with VP Payer, CPO, and Market President- Payer Growth on product narrative and revenue targets
• Develop product managers to unify risk analytics, suspecting, chart review, coding workflows, and audit trail tools into a seamless experience
• Enforce an AI-first development lifecycle (discovery, automated feedback synthesis, generative prototyping, intelligent backlog management)
• Partner across Engineering and Data Science to build and release scalably on the Healthcare Intelligence Cloud
• Define outcome-based success metrics such as chart review accuracy, suspecting yield, RADV audit mitigation rate, and coding velocity
• Serve as product authority for plan executives (CMOs, Chief Risk Officers, Actuarial Leads)
• Co-own revenue with Sales, Pre-Sales, and Customer Success (pitches, pursuits, upsell/cross-sell)
• Represent the Risk Adjustment perspective in external forums and regulatory consultations

Requirements

• 10+ years in Product Management or related technology leadership; 5+ years building and scaling Risk Adjustment, RADV/Audit, or Quality solutions for health plans/payers
• Deep domain expertise in Risk Adjustment (CMS-HCC, RxHCC, HHS-HCC) and coding workflows (ICD-10, MEAT criteria)
• Experience with retrospective chart reviews and prospective point-of-care nudges, plus RADV audit preparation
• Proven track record shipping AI/ML capabilities into healthcare workflows (NLP on unstructured clinical documentation, predictive suspecting, generative summaries for coders)
• Demonstrated success embedding SaaS products in complex payer environments and multi-payer enterprise systems
• Strong people leadership: hiring, mentoring, and scaling product teams and fostering AI adoption
• Exceptional memo-writing and executive presentation skills; comfortable discussing risk models, NLP accuracy, and ROI across stakeholders
• Bachelor’s degree required (Master’s preferred)

Benefits

• 20 days of fixed paid time off per year plus company holidays
• Best-in-class parental leave
• Recognition and rewards with monetary incentives
• Comprehensive insurance coverage (medical, dental, vision) plus 100% company-paid disability and basic life insurance; optional discounted legal aid and pet insurance