Product Manager-Healthcare Clinical Lead

edical Directors for cases requiring physician review or adverse determinations.

• Ensure UM decision-making complies with federal/state regulations, CMS requirements, NCQA/URAC standards, and timeliness expectations.
• Provide coaching to staff on documentation quality, criteria selection, and clinical justification.

Service Authorization Management

• Oversee the intake, triage, and review of service authorization requests (e.g., DME, home health, specialty services, behavioral health, advanced imaging).
• Ensure timely processing of authorizations within regulatory and contractual turnaround times (TATs).
• Review complex cases requiring clinical expertise and determine approval, modification, or need for medical director review.
• Monitor volume trends, authorization patterns, and provider issues to identify process improvements.

Care Management Integration

• Support transitions of care, coordination between UM and CM, and continuity across inpatient and outpatient settings.
• Participate in interdisciplinary rounds addressing high-risk, complex, or high-cost cases.
• Provide guidance to Care Managers on clinical issues impacting utilization, level of care, or benefit coverage.
• Collaborate with Care Management to identify members requiring engagement in case, disease, or population health programs.

Quality, Compliance & Accreditation

• Ensure compliance with CMS, state Medicaid, DOI, and accreditation standards related to UM/CM (NCQA, URAC).
• Conduct documentation audits and support corrective actions to maintain audit readiness.
• Assist in developing, updating, and implementing UM and CM policies, workflows, and clinical guidelines.
• Participate in regulatory audits, readiness reviews, and internal quality committees.

Operational Leadership & Staff Support

• Serve as a subject matter expert for clinical reviews, UM criteria, and service authorization workflows.
• Provide coaching, training, onboarding, and daily support to nurses, UM coordinators, and CM staff.
• Review cases for quality, accuracy, completeness, and compliance with organizational standards.
• Manage workload distribution, address barriers, and support issue resolution in real time.

Provider & Cross-Functional Collaboration

• Collaborate with providers on clinical documentation requirements, UM criteria, and decision rationales.
• Work with network providers to reduce unnecessary utilization and facilitate timely transitions of care.
• Partner with internal teams (Pharmacy, Behavioral Health, CM, Claims) to ensure seamless operations and problem resolution.

Data & Performance Monitoring

• Monitor UM metrics including:
  • Concurrent review timeliness
  • Appeals and overturn rates
  • Authorization turnaround times
  • Length of stay and readmission trends
  • High-utilization outliers
• Use analytics to identify trends, resource gaps, and opportunities to optimize utilization and member outcomes.

Core Competencies

• Clinical decision-making & critical thinking
• Knowledge of UM standards & clinical criteria
• Operational rigor & regulatory compliance
• Communication with members and providers
• Coaching, mentoring, and team leadership
• Workflow optimization & problem-solving
• Data-driven decision-making
• Collaboration across multidisciplinary teams

Required Qualifications

• The candidate must be located within commuting distance ofTempe, AZor be willing to relocate to this area.This position may require travel in the US.

• Bachelor's degree or foreign equivalent required from an accredited institution. Will also consider three years of progressive experience in the specialty in lieu of every year of Education.

• 7 Yrs of Domain experience (Healthcare).

• 5 yrs of clinical experience in utilization management, care management, or clinical review roles within a health plan, hospital, or integrated delivery system.

• Active, unrestricted RN license (or clinical licensure appropriate for UM, e.g., LPN in some markets, LCSW for integrated BH programs).

• Strong understanding of InterQual/MCG criteria, medical necessity reviews, and authorization processes.

• Knowledge of federal and state UM regulations, CMS guidelines, NCQA/URAC standards, and HIPAA.

• Excellent clinical judgment, communication, and documentation skills.

• Candidates authorized to work for any employer in the United States without employer-based visa sponsorship are welcome to apply. Infosys is unable to provide immigration sponsorship for this role at this time.

Preferred Qualifications

• Certification in Case Management or Utilization Management (CCM, ACM-RN, CPUR, CPHM).
• Experience with Medicare Advantage, Medicaid Managed Care, or Commercial health plans.
• Familiarity with UM and CM platforms (e.g., GuidingCare, MHK, HealthEdge, TruCare, CaseTrakker).
• Experience in provider relations, audit support, or process improvement initiatives.

Along with competitive pay, as a full-time Infosys employee you are also eligible for the following benefits:

• Medical/Dental/Vision/Life Insurance.
• Long-term/Short-term Disability.
• Health and Dependent Care Reimbursement Accounts.
• Insurance (Accident, Critical Illness, Hospital Indemnity, Legal).
• 401(k) plan and contributions dependent on salary level.
• Paid holidays plus Paid Time Off.

The job entails sitting as well as working at a computer for extended periods of time. Should be able to communicate by telephone, email or face to face. Travel may be required as per the job requirements.