Job Requirements
Role Summary We are seeking a clinically experienced, strategic leader to design and optimize evidence-based clinical pathways while aligning them with reimbursement strategies to maximize value-based and fee-for-service payments. This cross-functional role ensures pathways improve patient outcomes, reduce variability, and are tightly integrated with payer guidelines, prior authorization workflows, and documentation best practices. Responsibilities Clinical Pathway Development
- Design, build, and maintain evidence-based care pathways across service lines (e.g., oncology, orthopedics, cardiology, etc.)
- Translate clinical guidelines into operational workflows that are embedded in the EHR (e.g., order sets, alerts, documentation templates)
- Collaborate with multidisciplinary stakeholders including physicians, nurses, pharmacists, care coordinators, and IT
- Provide technical leadership and expertise in Software as a Medical Device, device design, design control, and manufacturing processes.
Reimbursement Strategy & Authorization Alignment
- Identify and embed payer-specific criteria, coding guidelines, and documentation requirements into clinical pathways
- Collaborate with revenue cycle, utilization management, and prior authorization teams to reduce denials and delays
- Proactively monitor changes in payer policy and ensure pathways remain compliant with coverage requirements
- Develop tools, templates, and staff education to support accurate coding and timely pre-authorization submission
- Track and analyze reimbursement trends and pathway-related financial performance (e.g., denial rates, case mix, cost capture)
Change Management & Education
- Lead training efforts to onboard clinicians and staff to new or updated pathways
- Drive adoption through regular feedback sessions, stakeholder engagement, and refinement cycles
- Improve processes, tooling, and reporting analytics
- Author and review human factors/usability engineering plans, clinical protocols and reports, and supportive design control documentation.
- Collaborate with cross-functional teams, including product development, clinical development, supply chain, commercial, quality, and regulatory affairs, to ensure successful project delivery
Outcomes Measurement & Continuous Improvement
- Define and monitor KPIs related to clinical quality, utilization, and financial impact (e.g., LOS, readmissions, reimbursement success)
- Leverage analytics to identify bottlenecks and improve pathway compliance, clinical appropriateness, and reimbursement outcomes
- Lead the Voice of the Customer data by coordinating and collaborating with external clinical subject matter experts and Key Opinion Leaders to understand and prioritize customer issues, and validate customer requirements
- Maintain a groomed prioritized feature and requirements backlog
- Lead and/or supervise strategic grooming for strategic and sustaining initiatives
- Lead and/or supervise KOL review of initiatives throughout the product lifecycle
Work Experience
Requirements
- Master level technical (process engineering) or clinical degree in a related area is a plus, or equivalent job-related experience.
- 5+ years in leading Product Management in medical imaging product development role
- At least 4 years of experience in creating product strategy
- At least 5 years of experience of product management process definition and supervising others
- 5+ years in clinical care or care management
- 2+ years in clinical transformation, utilization review, or pathway development
- Working knowledge of reimbursement models (FFS, DRG, bundled payments, value-based care)
- Experience collaborating with revenue cycle, payers, or pre-auth teams
- Strong background in medical imaging, advanced visualization, applications of AI and ML in medical imaging and clinical workflow applications with emphasis in image intensive specialties such as cardiology, vascular surgery, neurology and oncology
- Working knowledge of best KPIs to measure efficiency and efficacy of a PM team
- Deep understanding of payer requirements and coding practices
- Strong ability to link clinical workflows with financial and operational goals
- Project management, EHR workflow design (Epic/Cerner), and cross-functional collaboration
- Data analysis capabilities for tracking outcomes, trends, and reimbursement metrics
Preferred Traits:
- Systems thinker who understands both the clinical and business sides of healthcare
- Detail-oriented and proactive in managing payer-policy complexities
- Comfortable navigating matrixed organizations with multiple stakeholders
- Strong communicator with a passion for clinical and financial excellence
- Exude passion for customer satisfaction and drive an innovation culture based on continuous value delivery
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TeraRecon
Aug 14, 2025