Pay Range:
$98,100.00 - $163,400.00Please email [email protected] if you are a candidate seeking a reasonable accommodation for the application and/or interview process.
At BCBSRI, our greatest resource is our people.
We come from varying backgrounds, different cultures, and unique experiences. We are hard-working, caring, and creative individuals who collaborate, support one another, and grow together. Passion, empathy, and understanding are at the forefront of everything we do—not just for our members, but for our employees as well.
We recognize that to do your best work, you have to be your best self.
It’s why we offer flexible work arrangements that include remote and hybrid opportunities and paid time off. We provide tuition reimbursement and assist with student-loan repayment. We offer health, dental, and vision insurance as well as programs that support your mental health and well-being. We pay competitively, offer bonuses and investment plans, and are committed to growing and developing our employees.
Our culture is one of belonging.
We strive to be transparent and accountable. We believe in equipping our associates with the knowledge and resources they need to be successful. No matter where you’re at in the organization, you’re an integral part of our team and your input, thoughts, and ideas are valued.
Join others who value a workplace for all.
We appreciate and celebrate everything that makes us unique, from personal characteristics to past experiences. Our different perspectives strengthen us as an organization and help us better serve all Rhode Islanders.
We’re dedicated to serving Rhode Islanders.
Our focus extends beyond providing access to high-quality, affordable, and equitable care. To further improve the health and well-being of our fellow Rhode Islanders, we regularly roll up our sleeves and get to work (literally) in communities all across the state—building homes, working in food pantries, revitalizing community centers, and transforming outdoor spaces for children and adults. Because we believe it is our collective responsibility to uplift our fellow Rhode Islanders when and where we can, our associates receive additional paid time to volunteer.
Why this job matters:
Data-driven Product Manager Product Manager to oversee the day-to-day implementation and enhancement of our clinical integration and interoperability capabilities. This role will be responsible for managing implementation CMS-0057 compliance initiatives, Azure-based FHIR data ingestion pipeline, and bi-directional integration with EHR systems. The Product Manager will work closely with engineering, clinical, compliance, and external partners to deliver scalable, standards-based healthcare interoperability solutions.
What you’ll do:
Drive the Clinical and Interoperability pod strategy and execution, focusing on compliance, scalability, and provider impact.
Lead implementation of CMS-0057 including Provider Access APIs, Prior Authorization workflows (CRD, DTR, PAS), and Payer-to-Payer Data Exchange.
Oversee ingestion of clinical data using FHIR APIs via Azure Health Data Services, using FHIR APIs via Azure Health Data Services, Azure Functions (Python and C#), and Azure Data Factory.
Manage bi-directional EHR integration efforts using FHIR, HL7v2, and other healthcare data standards.
Ensure all interoperability components align with Azure-native architecture and HIPAA compliance requirements.
Work with internal Data Governance teams to support data lineage, metadata, and data quality initiatives.
Translate clinical and technical requirements into clear product specifications for development teams.
Collaborate with EHR vendors and provider partners to streamline data exchange and onboarding.
Collaborate with RISK Adjustment Team and Quality Gap stakeholders to ensure FHIR clinical data is flowing as expected and is being harnessed for the appropriate inputs around HCC risk score and care gaps
Maintain ,build processes & Control around existing EMR eco systems and govern accordingly
Engage stakeholders across payer, provider, and technical teams to drive adoption and usage.
Stay informed on regulatory changes, FHIR enhancements, and interoperability trends like TEFCA and USCDI+.
What you need to succeed:
5+ years of experience in healthcare, health IT, or payer systems.
knowledge of CMS-0057, Da Vinci Implementation Guides (PAS, CRD, DTR), and interoperability frameworks.
Experience working with FHIR, HL7v2, CCDA, and clinical data ingestion workflows.
Proficient in SQL and experience working with Snowflake or similar cloud data platforms.
Experience with Python for data processing, validation, or ETL orchestration.
Familiarity with Power BI dashboard development and self-service analytics practices.
Demonstrated experience collaborating with analytics, data engineering, and governance teams.
Ability to manage agile teams, prioritize backlogs, and deliver outcomes in cross-functional settings.
The Extras:
Experience with payer-provider interoperability platforms, TEFCA, or care coordination tools.
Knowledge of value-based care, risk adjustment (HCC coding), and HEDIS/STAR measure implications.
Location:
BCBSRI is headquartered in downtown Providence, conveniently located near the train station and bus terminal. We actively support associate well-being and work/life balance and offer the following schedules, based on role:
Our culture of belonging at Blue Cross & Blue Shield of Rhode Island (BCBSRI) is at the core of all we do, and it strengthens our ability to meet the challenges of today’s healthcare industry. BCBSRI is an equal opportunity employer.
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