Lead Product Owner / Business Integration Lead (Prior Authorization)
Location/Work model: 100% Remote (must work Eastern Time core hours )
Type: Contract (~ 7 months , Possible extension)
Compensation: $72/HR
About the role
We’re looking for a Lead Product Owner / Business Integration Lead to stabilize and improve end-to-end Prior Authorization (PA) operations and the supporting technology/process integrations. This is a true hybrid role (Product Owner + Business Integration Lead) focused on fixing real breakdowns in the PA-to-claims flow—identifying failure points, driving corrective action, and delivering improvements that impact accuracy, turnaround time, and provider experience .
This role is ideal for someone who has deep payer-side PA domain expertise and can confidently partner across clinical, IT, claims, and operations to drive solutions through to completion.
Must-have systems/standards:
• FACETS (including claims-to-operations “matching”)
• GuidingCare (especially downstream workflow after the authorization leaves GuidingCare)
• EDI 278
What you’ll do (Day-to-day)
• Own end-to-end Prior Authorization (PA) program delivery across clinical, technical, and operational teams.
• Lead requirements work: gather, document, validate, and manage functional/non-functional requirements , translating them into user stories and acceptance criteria .
• Drive cross-functional execution across multiple workstreams: stakeholder workshops, design reviews, issue triage, and delivery planning.
• Identify and resolve breakdowns/errors in the PA/claims process—pinpoint fail points and implement fixes/workarounds with clinical + IT teams.
• Lead UAT planning and execution: test plans, defect documentation, coordination of fixes, and release readiness.
• Track and improve PA performance metrics (e.g., turnaround time, denials, provider friction, auto-decision rates ).
• Support change communications/training and provide guidance to other analysts.
Must-Haves (Required)
Domain / Experience
• Deep end-to-end Prior Authorization expertise (not just general “healthcare IT”).
• 15+ years in payer operations / healthcare delivery / utilization management / PA programs .
• 8–10+ years operating as a Product Owner (or equivalent end-to-end product delivery lead) in a payer/healthcare environment.
• Proven ability to lead large, cross-functional, multi-workstream initiatives and drive outcomes to closure.
• Strong skills in requirements, stakeholder management, process/systems analysis, issue management, and executive-ready communication.
Systems / Workflow Knowledge (must be able to speak to the flow end-to-end)
• FACETS: working knowledge of claims-to-operations “matching” and how PA/claims flow connects downstream (this is emphasized as critical).
• GuidingCare: working knowledge, especially what happens after the authorization leaves GuidingCare .
• EDI 278 experience/knowledge.
Nice-to-Haves (Preferred)
• MBA (Bachelor’s required or equivalent additional relevant experience).
• Prior experience helping drive a “task force” / stabilization effort where there are ongoing errors and high-visibility corrective actions.
Education
• Bachelor’s degree in Business Administration/Management/Finance (or related) or equivalent experience
• MBA preferred
Quick “Must-Have Keywords” (for screening/search)
Prior Authorization (PA) | Utilization Management | Product Owner | Business Integration | FACETS | Claims matching | GuidingCare | EDI 278 | UAT | Requirements | User stories | Acceptance criteria
System One, and its subsidiaries including Joulé and Mountain Ltd., are leaders in delivering outsourced services and workforce solutions across North America. We help clients get work done more efficiently and economically, without compromising quality. System One not only serves as a valued partner for our clients, but we offer eligible employees health and welfare benefits coverage options including medical, dental, vision, spending accounts, life insurance, voluntary plans, as well as participation in a 401(k) plan.
System One is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, age, national origin, disability, family care or medical leave status, genetic information, veteran status, marital status, or any other characteristic protected by applicable federal, state, or local law.
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Ref: #851-Rockville-S1 8 Employment Type: CONTRACTOR