Director, Utilization Management Operations

Job not on LinkedIn

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $182k - $247k / year

⏰ Full Time

🔴 Lead

⚙️ Operations

👻 Ghost score 0%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Devoted Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2017

🏥 Healthcare

⚕️ Healthcare Insurance

🧘 Wellness

Healthcare • Healthcare Insurance • Wellness

Devoted Health is a healthcare company that offers Medicare Advantage plans designed to provide comprehensive health coverage with added benefits like dental, eyewear, gym memberships, and prescription drugs at competitive rates. The company emphasizes member support and service, ensuring that clients can easily navigate their benefits and access needed healthcare services. Devoted Health is committed to helping customers save money and enhance their health and wellness through a complete package of benefits and support.

📋 Description

• Own SLA performance for administrative steps supporting authorization review across utilization management • Hold dotted-line accountability for Part B medical authorization turnaround times, partnering with clinical leaders to monitor performance, surface risks, and remove administrative barriers • Map and redesign end-to-end administrative processes including authorization intake, clinical information requests, facility census checks, notifications, and follow-up • Partner with Product and Engineering to shape the Orinoco technology roadmap • Implement integrated AI tools to reduce manual effort and administrative capacity growth • Design measurable and transparent processes and define and monitor KPIs including timeliness, cost per authorization, quality, and provider experience • Lead and develop approximately 50 onshore UM Administrative Coordinators and their leaders • Manage an offshore vendor partnership supporting more than 250 administrative team members • Partner with Provider Network to incorporate provider and facility needs into the process • Design member and provider outreach, notifications, and follow-up touchpoints • Collaborate with the Senior Director of UM, UM Medical Directors, Compliance, Provider Network, Data Science, and Engineering teams • Keep the operation aligned and consistently audit-ready

🎯 Requirements

• Genuine commitment to treating members like family, and belief that operational excellence and empathy belong together • Track record of leading high-volume operations that deliver consistent SLA performance • Experience taking a complex, multi-step process apart and leading the build of a simpler, more scalable one • Comfortable working deep in workflows and data and using both to drive decisions and accountability • Experience partnering with product and engineering teams • Genuine excitement about using AI-enabled tools to transform how work gets done • Experience managing vendor partners against clear performance and quality standards • Exceptional written and verbal communication skills • Bachelor’s degree required • Experience in payer operations, utilization management, claims, provider revenue cycle, or a similar high-volume healthcare environment is desired • Understanding of Medicare Advantage operations and CMS requirements is desired • 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 • Parental leave program • 401K program • Bonus eligibility for all roles excluding Director and above • Commission eligibility for Sales roles

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume