Note: The job is a remote job and is open to candidates in USA. Devoted Health is on a mission to dramatically improve the health and well-being of its members by treating them like family. The Director of Utilization Management Operations will lead a team to ensure efficient utilization management processes while bridging clinical needs with business operations.
Responsibilities
- Provide leadership and professional development to clinical and non-clinical teams
- Directly lead a team of Senior Managers and Managers who oversee teams of nurses and intake coordinators
- Manage our offshore partnership, ensuring their performance metrics and workflows are aligned with department targets
- Evaluate and prioritize improvement opportunities to ensure our technology supports accurate and efficient workflows
- Be engaged with our AI tools for process and platform improvement while ensuring strict compliance with our AI Governance and Oversight policies
- Partner closely with Data Science and Engineering teams to identify key measurement points
- Develop, implement, and systematically monitor comprehensive KPIs to ensure operational health and decision accuracy
- Partner with Compliance and Legal teams to ensure the operation is consistently audit-ready
- Digest complex regulatory guidance and translate it into compliant, high-quality operational workflows
- Act as a close partner to the Provider Network team to ensure our operation is responsive to feedback from provider and facility partners
- Partner with Pharmacy UM and the UM Medical Director team to facilitate appropriate service use and minimize care barriers
Skills
- Demonstrated experience leading large clinical teams. An understanding of the nuance required when managing clinicians and healthcare workflows is essential
- A track record of transforming complex operational challenges into scalable business processes in a fast-paced environment
- A data-driven mindset with the ability to use insights to drive decisions. You should have a genuine interest or experience in leveraging AI-enabled tools to optimize clinical workflows
- High ethical standards with the ability to master complex regulatory guidance and incorporate it into daily operations
- Exceptional written and verbal communication skills, with the ability to distill complex problems into actionable updates for leadership
- Prior experience in Utilization Management processes and the medical necessity review lifecycle is highly beneficial but not strictly required if clinical leadership experience is strong
- Familiarity with Medicare Advantage operations and CMS guidelines
- MBA or advanced degree in health administration or finance is a plus
Benefits
- Employer sponsored health, dental and vision plan with low or no premium
- Generous paid time off
- $100 monthly mobile or internet stipend
- Stock options for all employees
- Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles
- Parental leave program
- 401K program
Company Overview