Senior Product Manager, HIE, AI Suspecting, and Care Gap Management

Job description

Senior Product Manager, HIE, AI Suspecting, and Care Gap Management Remote Opportunity About Reveleer Reveleer delivers a unified platform spanning risk adjustment, quality improvement, clinical intelligence, and member management for health plans and provider organizations navigating the complexity of value-based care. Trusted by 80+ customer organizations nationwide, the platform integrates data, analytics, and intelligent workflow automation into one governed system designed to support traceable documentation across diagnoses, quality measures, and submissions. With regulatory expertise and transparent, human-in-the-loop AI at its core, Reveleer supports organizations working to advance care quality, strengthen documentation integrity, and sustain the operational readiness needed to navigate audits with confidence. About the role Rev eleer is hiring a Senior Product Manager to lead product for both the HIE & AI Suspecting and Care Gap Manager domains within our Clinical Intelligence Suite of VBC solutions. The HIE and AI Suspecting product involves the retrieval of unstructured clinical data from health information exchanges (HIEs) and customers and applies AI suspecting to surface diagnosis and quality opportunities from that data. Care Gap informanager provides health plans and providers a common workbench to manage quality and risk care gaps, submit clinical evidence, and track incentive progress to align on and ensure the highest performance in their value-based arrangement. The pods currently own separate links in one chain: retrieving clinical data, identifying opportunities, and closing gaps with provider evidence to support a highly effective and efficient VBC relationship. The Senior Product Manager sets the direction for how those links connect into one workflow for health plans and provider groups, then sequences work across both pods to build it. The role combines product strategy, vendor management, regulatory tracking, and provider-facing workflow design. The person in this seat becomes the subject matter expert on HIEs within Clinical Intelligence: how they're structured, what regulations govern access and exchange, and what Reveleer's platform needs to build or change to keep pace. The same person holds the product depth on Care Gap Manager: how health plans configure quality and risk programs, how provider groups close gaps, and how incentive programs motivate that work. What you'll own Cross-pod vision and unification · Define and communicate a multi-year product vision that unifies the HIE & AI Suspecting pod and the Care Gap Manager pod, connecting data retrieval, AI suspecting, gap delivery, evidence submission, and gap closure into one workflow for health plans and provider groups. · Sequence investments across both pods into one prioritized ro admap, make trade-offs between pod-level and platform-level work explicit, and align both pods with the Reveleer Prospective workflows so risk and quality programs reuse data and workflows instead of duplicating them. Product strategy and ro admap · Define and prioritize the ro admap for both pods based on customer and internal operations needs, data retrieval performance, AI suspecting accuracy, and Care Gap Manager adoption and gap closure outcomes. · Le ad and participate in all agile ceremonies as the product representative for both pods, including daily standups, backlog refinement, sprint planning, biweekly and monthly product management meetings, and retrospectives. · Partner with engineering and clinical teams to translate HIE, health plan, and provider group requirements into product requirements, maintaining accurate Product Requirements Documentation (PRDs) for all new feature development. · Set and track success metrics for retrieval coverage, data completeness, suspecting accuracy, gap closure rate, evidence validation turnaround, provider activation, and provider satisfaction (CSAT). · Own product documentation for both pods and work with other product le aders and Product Marketing (PMM) to train internal teams on HIE knowledge and product capabilities. HIE vendor relationships · Own commercial and technical relationships with HIE vendors and network partners, including onboarding, contract renewals, and issue escalation. · Negotiate data access terms and service levels that support Reveleer's retrieval and coverage goals. · Serve as the primary point of contact between Reveleer and HIE partners for product and integration questions. · Set the multi-year HIE portfolio strategy, including which exchanges and networks to add, expand, or consolidate based on coverage and accuracy gains for both AI suspecting and gap delivery. Regulatory and industry expertise · Track federal and state regulation affecting HIE data access, including information blocking rules, TEFCA, and state-level health information exchange requirements. · Inform internal stakeholders, including legal, compliance, engineering, and executive leadership, on what regulatory changes mean for Reveleer's broader data retrieval capabilities. · Maintain a working knowledge of the national and regional HIE landscape: which exchanges cover which geographies, how they differ in data format and access model, and where new exchanges or consolidations are changing the map. · Investigate any reported issues and prioritize engineering support as appropriate to reach resolution. Communicating resolutions back to customer support where appropriate. · Liaising with our compliance and legal teams to further shape our internal process and policy for triaging and reporting PHI-related issues as it relates to data received and reciprocated to HIEs and managing adherence to these policies. · Partner with Compliance and Legal to keep Care Gap Manager aligned with HIPAA and HITRUST requirements, including customer data segregation in a multi-tenant environment and audit-re ady evidence logging. Cross-functional le adership · Coordinate with adjacent pods that consume HIE data, including Hybrid AI, Point of Care, and Data Engineering, and with other teams in the Prospective Workflows family, to align roadmaps and shared dependencies. · Communicate ro admap, vendor status, regulatory risk, and progress against the unified vision to leadership on a regular cadence. · Work with data engineering to prioritize which HIE connections and data types deliver the greatest coverage and accuracy gains, and which data foundations AI suspecting and Care Gap Manager share. What you'll need · An AI -native Product Management mindset leveraging AI as a tool within your role and as a technology to guide the evolution of your domains and the broader platform. · Six or more years of product management experience, with at least three to four years in healthcare data, health IT, or interoperability, and a record of owning a roadmap that spans multiple teams or products. · Demonstrated experience defining product vision and strategy across multiple teams or products, and aligning engineering, clinical, and executive le aders around it. · Direct experience working with or negotiating with HIEs, health information networks, or clinical data exchange vendors. · Working knowledge of healthcare interoperability standards (HL7, FHIR, C-CDA) and how unstructured clinical data moves between systems. · Familiarity with the regulatory environment governing health information exchange, including information blocking rules and TEFCA. · Working knowledge of the Healthcare Effectiveness Data and Information Set (HEDIS), CMS Stars, and risk adjustment, including risk adjustment factor (RAF) scoring and hierarchical condition categories (HCCs), and of how health plans manage quality and risk gaps and how provider groups close them. · Experience owning B2B SaaS products with more than one user type, such as health plan administrators and provider-facing portals, and configuration-driven workflows. · Strong vendor management skills: contract negotiation, relationship management, and escalation handling. · Strong communication skills: working cross-functionally on new product development initiatives and influencing internal and external stakeholders, including customers. · Comfort operating as the go-to internal expert on a technical and regulatory subject area, including presenting to non-technical stakeholders and executive leadership. · Ability to influence without direct authority across pods, and to mentor product managers and analysts. · Experience with AI-driven suspecting, coding, or diagnosis capture in a Medicare Advantage or value-based care setting. Nice to have · Prior experience at a payer, health system, or HIE itself. · Experience with care gap closure, supplemental data submission, or provider engagement platforms for health plans, including incentive program display and omni-channel outreach. · Experience across more than one line of business, such as Medicare Advantage, Medicaid managed care, FEP, and Commercial or ACA exchange. · Familiarity with HIPAA and HITRUST requirements for multi-tenant SaaS products that handle PHI. WHAT YOU’LL RECEIVE • Competitive salary • Medical, Dental and Vision benefits • 401k match • Generous PTO plan Our compensation reflects the cost of labor across several US geographic markets. Pay is based on several factors including market location and may vary depending on job-related knowledge, skills, and experience. Reveleer E-Verifies all new hires. Reveleer is an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, gender identity, sexual orientation, age, marital status, veteran status, disability status or genetic information, in compliance with applicable federal, state and local law.