[Remote] Director, Utilization Management Operations

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 each of them like family. They are seeking a Director of Utilization Management Operations to lead a team that bridges complex clinical needs with efficient business processes, ensuring timely and accurate decisions in utilization management.

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

Company Overview