Job Description

This role is fully remote and must be located within the 50 U.S. states. Standard working hours are in Eastern Timezone. Semi-annual travel may be required to a Devoted office for on-site work.

We are seeking a leader to serve as the Director of Utilization Management Operations. This individual will be a cornerstone of our Health Services division, bridging the gap between complex clinical needs and scalable, efficient business processes. You will lead a team of clinicians and coordinators, alongside a critical offshore vendor partnership, to ensure our utilization management processes deliver timely and accurate decisions.

Your Responsibilities and Impact will include:

• Mission-Driven Clinical Leadership: Provide leadership and professional development to clinical and non-clinical teams. You will foster a culture of integrity and clinical excellence, ensuring all UM activities align with Devoted's goal of treating members like family.
• People & Vendor Management: Directly lead a team of Senior Managers and Managers who oversee teams of nurses and intake coordinators. You will also manage our offshore partnership, ensuring their performance metrics and workflows are aligned with department targets.
• Technology & AI Stewardship: We utilize a single internal technology platform across our business. You will play a key role in evaluating and prioritizing improvement opportunities to ensure our technology supports accurate and efficient workflows. You will be engaged with our AI tools for process and platform improvement while ensuring strict compliance with our AI Governance and Oversight policies.
• Data-Driven Operations: Partner closely with Data Science and Engineering teams to identify key measurement points. You will be responsible for developing, implementing, and systematically monitoring comprehensive KPIs to ensure operational health and decision accuracy.
• Regulatory & Compliance Excellence: Partner with Compliance and Legal teams to ensure the operation is consistently audit-ready. You will digest complex regulatory guidance (e.g., NCDs, LCDs, Medicare Managed Care Manual) and translate it into compliant, high-quality operational workflows.
• Strategic Stakeholder Collaboration: Act as a close partner to the Provider Network team to ensure our operation is responsive to feedback from provider and facility partners. You will also partner with Pharmacy UM and the UM Medical Director team to facilitate appropriate service use and minimize care barriers.

Required skills and experience:

• 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.

Desired skills and experience:

• 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.

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Salary range: $182,000 - 248,000 / year

The pay range listed for this position is the range the organization reasonably and in good faith expects to pay for this position at the time of the posting. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered will depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.

Our Total Rewards package includes:

• 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
• And more....

*Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.