Product Owner- Healthcare (Capitation Experience)

Job Summary

We are seeking an experienced Product Owner with strong Healthcare domain expertise and hands-on experience in Capitation payment models. The ideal candidate will work closely with business stakeholders, clinical operations, engineering teams, and external partners to define and deliver innovative healthcare products that support value-based care, capitation, provider reimbursement, and population health initiatives.

The Product Owner will be responsible for translating business needs into detailed product requirements, prioritizing the product backlog, and ensuring successful delivery of healthcare solutions aligned with organizational goals.

Key Responsibilities

• Own and manage the product backlog, ensuring alignment with business priorities and strategic objectives.
• Collaborate with business stakeholders, healthcare operations, provider network teams, and engineering teams to gather and refine requirements.
• Define product vision, roadmap, and release planning for healthcare applications.
• Write detailed user stories with clear acceptance criteria.
• Prioritize features based on business value, regulatory requirements, and customer needs.
• Participate in Agile ceremonies including Sprint Planning, Daily Standups, Sprint Reviews, and Retrospectives.
• Serve as the primary liaison between business users and development teams.
• Drive product decisions related to:
• Capitation payment models
• Provider reimbursement
• Value-Based Care (VBC)
• Risk Adjustment
• Population Health Management
• Claims processing
• Member eligibility
• Provider contracts
• Ensure compliance with healthcare regulations including HIPAA and CMS guidelines.
• Analyze product performance using KPIs and recommend enhancements.
• Support User Acceptance Testing (UAT) and production releases.
• Collaborate with QA teams to validate delivered functionality.

Required Qualifications

• Bachelor's degree in Business, Healthcare Administration, Information Systems, Computer Science, or related field.
• 5+ years of Product Owner.
• 5+ years of Healthcare domain experience.
• Strong experience working with Capitation payment models.
• Experience supporting:
• Managed Care Organizations (MCOs)
• Health Plans
• Medicare
• Medicaid
• Commercial Healthcare
• Deep understanding of:
• Provider contracts
• Claims adjudication
• Member enrollment
• Eligibility
• Provider data management
• Care management
• Experience with Agile/Scrum methodologies.
• Strong experience creating user stories and managing product backlogs.
• Excellent communication and stakeholder management skills.

Preferred Qualifications

• Experience with Value-Based Care (VBC) initiatives.
• Knowledge of Risk Adjustment (HCC).
• Familiarity with CMS regulations.
• Experience with healthcare interoperability standards such as HL7 and FHIR.
• Knowledge of EDI transactions including 837, 835, and 278.
• Experience with Jira, Confluence, Azure DevOps, or similar Agile tools.
• Certified Scrum Product Owner (CSPO) certification preferred.
• SAFe Product Owner/Product Manager certification is a plus.

Required Technical Skills

• Agile / Scrum
• Jira
• Azure DevOps
• Confluence
• SQL (preferred)
• Data analysis and reporting
• REST APIs (preferred)
• Healthcare data models

Healthcare Domain Expertise

Candidates should have experience in one or more of the following:

• Capitation
• Value-Based Care (VBC)
• Population Health Management
• Provider Network Management
• Provider Reimbursement
• Claims Processing
• Member Enrollment & Eligibility
• Care Management
• Utilization Management
• Medicare & Medicaid
• Risk Adjustment
• HEDIS
• Quality Measures

Soft Skills

• Strong analytical and problem-solving abilities.
• Excellent verbal and written communication skills.
• Ability to manage multiple priorities in a fast-paced environment.
• Strong leadership and decision-making skills.
• Excellent stakeholder management and collaboration skills.
• Customer-focused mindset with attention to detail.

Pay: $50.00 - $60.00 per hour

Work Location: Remote