Product Manager, CMS Integrations

Overview

Overview: 

HealthEdge is seeking a Product Manager to own the CMS integration strategy and API connectivity roadmap for HealthRules® Payer. As federal programs expand their digital infrastructure – from MACPro and the CMS Data Services Hub to FHIR-based interoperability mandates and real-time eligibility connectivity – health plans require a platform that integrates reliably, securely and in full compliance with CMS technical specifications. 

In this role, you will define, prioritize and drive the product requirements that govern how HealthRules Payer connects to CMS federal systems, third-party payer platforms and health plan operational infrastructure. You will own the integration catalog, API design standards, connector framework and the requirements that ensure every CMS-mandated data exchange is accurate, auditable and aligned to current CMS technical specifications and certification requirements. 

 You will partner closely with engineering, solution architecture, implementation and client success teams to ensure HealthRules Payer integrations are production-grade, scalable and supportable – and that health plan clients can onboard, certify and operate CMS integrations with minimal friction and maximum confidence. 

What You Will Own 

The end-to-end integration product strategy for HealthRules Payer – spanning CMS federal system connections, standard API and connector frameworks, FHIR-based interoperability, EDI/batch data exchange and the certification and compliance requirements that govern each integration domain. 

 

CMS INTEGRATION LANDSCAPE 

The following CMS federal systems represent the core integration surface area this role owns within HealthRules Payer. The PM is responsible for defining and maintaining product requirements across all active and planned integrations within this catalog.

WHAT YOU'LL DO 

CMS Integration Strategy & Roadmap 

• Own and maintain the HealthRules Payer CMS integration catalog – defining the current state of each integration, its certification status, data exchange scope, technical specification version and planned roadmap investments. 

• Develop and drive the multi-year CMS integration roadmap for HealthRules Payer, aligning integration investments with CMS regulatory milestones, federal rulemaking timelines and client demand signals. 

• Evaluate new and evolving CMS system requirements – including FHIR API mandates under the Interoperability and Prior Authorization Final Rule (CMS-0057-F), CMS Data Services Hub enhancements and MACPro/MACFin modernization efforts – and translate obligations into HealthRules Payer integration requirements. 

• Define the integration architecture principles for HealthRules Payer, establishing standards for API design, connector reuse, payload validation, error handling and integration observability in partnership with engineering and solution architecture. 

• Monitor CMS technical bulletin releases, data services hub announcements and federal system decommission or migration notices, proactively assessing impact on HealthRules Payer integration continuity and driving necessary updates through the product backlog. 

 API Design & Connector Framework 

• Own product requirements for the HealthRules Payer API layer – defining RESTful API contracts, FHIR R4 resource profiles, authentication standards (OAuth 2.0, SMART on FHIR) and versioning policies that govern how internal and external systems connect to HealthRules Payer. 

• Define requirements for a reusable connector framework within HealthRules Payer that enables health plan clients to configure, activate and monitor CMS system integrations without custom development – reducing implementation time and ongoing maintenance burden. 

• Establish API design standards for HealthRules Payer outbound and inbound integrations, including payload schema definitions, error code taxonomy, retry logic, rate limiting and API lifecycle governance. 

• Partner with engineering to define integration testing requirements – including unit, contract, regression and end-to-end testing protocols – ensuring each CMS integration maintains specification compliance across HealthRules Payer release cycles. 

• Define product requirements for an integration monitoring and observability capability within HealthRules Payer, enabling health plan clients and HealthEdge operations teams to track integration health, transaction volumes, error rates and SLA performance in real time. 

 FHIR & Interoperability Compliance 

• Own product requirements for HealthRules Payer FHIR R4 API capabilities mandated und