Note: The job is a remote job and is open to candidates in USA. Medisolv, Inc. is a healthcare quality company that partners with hospitals, health systems, ACOs, and payers to improve performance through data analytics and AI. The Senior Product Manager will lead the development and deployment of AI-driven solutions to enhance value-based care and CMS quality metrics, focusing on payer data integration and actionable insights. This role requires collaboration across engineering, AI, and clinical teams to optimize healthcare outcomes and advance Medisolv's platform capabilities.
Responsibilities
- Build a deep understanding of Medisolv’s data ecosystem and CMS measure logic (HEDIS, Pharmacy, CAHPS/HOS)
- Align with engineering, AI, and clinical stakeholders on priorities and high-impact use cases
- Define initial AI agent architecture and guiding principles for HITL safety and compliance
- Design and prototype AI agents to identify care gaps and predict Star Rating risks
- Stand up the foundation of the payer data core from fragmented datasets
- Develop initial CMS measure calculation engines and pilot action-oriented workflows
- Deploy production-ready AI agents that connect insights directly to gap-closing actions
- Expand and stabilize the payer data core and measurement automation
- Implement orchestrated workflows and mature HITL guardrails
- Optimize AI performance with feedback loops and expand to more advanced use cases
- Mature the data platform into a scalable, real-time decisioning engine
- Drive measurable improvements in Star Ratings and value-based care outcomes
Skills
- 5+ years of product management experience handling health plan data and VBC provider quality metrics
- Deep understanding of risk adjustment, utilization management, and how risk-bearing entities operate
- Expertise in how CMS calculates MA Star Ratings
- Understanding of the math behind cut points, the impact of triple-weighted measures, and how to build data products that move the needle across various CMS measure domains
- Hands-on experience working with claims, eligibility, and enrollment datasets
- Ability to map claims, eligibility, and enrollment datasets back to quality performance
- Desire to build proactive software that thinks, adapts, and automates workflows rather than just reporting on them
- Understanding of GenAI architectures, RAG, and agentic frameworks (like LangChain, AutoGen, or similar orchestration toolsets)
- Comfortable talking to engineers about vector databases, APIs, and semantic data layers
- Knowledge of how to build within HIPAA/HITRUST guidelines and ensure AI outputs are accurate, unbiased, and explainable
- Ability to take initiative and enjoy driving tasks from inception to completion
- Demonstrated empathy for colleagues and ability to influence cross-functional collaboration
- Flexibility in approach and expectations in a growth stage company
- Intellectual curiosity and a love for challenges
- Ability to articulate areas of personal improvement over time
- Optimism and resilience in the face of change
Company Overview