Key skills
U.S. healthcare payer operationsHealthcare claims adjudicationProvider reimbursementBenefit administrationPayer analyticsHealthcare interoperabilityValue-based care programsHealthcare utilization managementPrior authorization workflowsHealthcare product managementHealthcare consultingHealthcare technology strategyCMS Interoperability and Prior Authorization Final Rule (CMS-0057-F)FHIRHealthcare analyticsPopulation healthQuality measurementRisk adjustmentPayment integrityCare management solutionsValue-based payment modelsACOBundled paymentsShared savings arrangementsCapitationGenerative AIAI technologiesHealthcare technology modernizationDigital transformationExecutive communicationStakeholder managementGoAIAnalyticsOracleLeadershipStakeholder ManagementStrategic PlanningProduct ManagementCommunicationCustomer SuccessSales
About this role
NetSuite is seeking a strategic Product Manager to help define and drive Oracle Health’s healthcare payer strategy in the United States. In this role, you will serve as a market-facing product leader responsible for shaping the roadmap, positioning, and go-to-market strategy for Oracle’s healthcare payer solutions.
Responsibilities:
- Define and help execute the product strategy and go-to-market vision for Oracle Health's healthcare payer solutions in the United States
- Serve as a trusted advisor and product strategist for executive stakeholders at health plans, managed care organizations, government payers, and other healthcare organizations
- Engage with prospective and existing customers to articulate Oracle Health's strategic vision and demonstrate the business value of our healthcare payer platform
- Analyze healthcare market trends, competitive dynamics, regulatory developments, and emerging business models to identify strategic product opportunities
- Influence product roadmap priorities across payer solution domains including claims adjudication, interoperability, analytics, contract management, benefit plan administration, provider reimbursement, and value-based care automation
- Partner with product development and engineering teams to ensure strategic priorities are reflected in product investments and platform capabilities
- Collaborate with sales, consulting, implementation, and customer success organizations to support strategic customer engagements and market growth initiatives
- Develop business cases and strategic recommendations that support product investment decisions and market expansion opportunities
- Represent Oracle Health at industry events, customer forums, advisory boards, and executive briefings
- Establish and maintain relationships with industry thought leaders, healthcare organizations, regulatory stakeholders, and strategic partners
- Provide strategic guidance and mentorship to product managers working within specific payer solution domains
Requirements:
- Deep expertise in U.S. healthcare payer operations and business processes
- Strong understanding of healthcare claims adjudication, provider reimbursement, benefit administration, payer analytics, interoperability, and value-based care programs
- Strong understanding of healthcare utilization management, prior authorization workflows, and the operational interactions between authorization, claims adjudication, provider reimbursement, and medical management processes
- Experience working with healthcare payer operations related to utilization management, care management, prior authorization, claims administration, or provider operations
- Experience in product management, healthcare consulting, payer operations leadership, healthcare technology strategy, or a related role
- Demonstrated success developing product strategy, market strategy, or business transformation initiatives within healthcare payer organizations
- Strong executive communication, presentation, and stakeholder management skills
- Experience engaging with senior leaders and executive decision-makers within healthcare organizations
- Experience working with commercial health plans, Blues plans, Medicare Advantage organizations, Medicaid managed care organizations, or government healthcare programs
- Experience with prior authorization platforms, utilization management systems, care management solutions, or provider engagement technologies
- Knowledge of CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) and emerging industry standards supporting electronic prior authorization workflows
- Knowledge of healthcare interoperability standards and regulatory programs, including FHIR and CMS interoperability requirements
- Experience with healthcare analytics, population health, quality measurement, risk adjustment, payment integrity, and care management solutions
- Knowledge of value-based payment models and reimbursement methodologies, including ACOs, bundled payments, shared savings arrangements, and capitation
- Understanding of healthcare benefit configuration, contract modeling, network management, and provider reimbursement strategies
- Demonstrated expertise in leveraging generative AI and advanced AI technologies to support market analysis, strategic planning, customer engagement, product innovation, and decision-making
- Proven ability to identify opportunities for AI-enabled transformation across healthcare payer operations and technology platforms
- Experience supporting large-scale healthcare technology modernization or digital transformation initiatives