Director, Utilization Management Operations

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.

A bit about this role:

At Devoted, our mission is to dramatically improve the health and well-being of our members by treating each of them like family. Devoted is growing at an incredible pace, and we are thrilled to welcome and serve every new member who joins us. This growth demands that our Utilization Management (UM) operation must scale and evolve without ever losing sight of the people at the center of every authorization.

We believe UM done right means decisions that are correct, fair, and fast, delivered through a frictionless process and with heart. Behind every request is a member waiting on care and a provider working to deliver it. UM is hard, but the challenge doesn’t exempt us from our mission.

We are seeking a curious, operationally minded leader to serve as Director, Utilization Management Operations. Reporting to the Vice President of Health Services, you will lead the teams behind our administrative work: a large onshore and offshore team of UM Administrative Coordinators who manage intake, outreach, notifications, and follow-up. You will also hold dotted-line accountability for monitoring and ensuring the success of our Part B medical authorization turnaround times (TAT).

This role is for someone who is energized by a complex process: someone who wants to unravel it, reimagine it, and lead the build of something simpler, faster, and more consistent. You will have significant influence over the roadmap for Orinoco, our internal technology platform, and an integrated AI engine to put to work. This role will help pave the way towards realizing the next generation of our UM program, driving improvements in effectiveness, efficiency, and experience for our members and provider partners.

Your Responsibilities and Impact will include:

• SLA & Timeliness Ownership: Own SLA performance for the administrative steps that support authorization review across UM, delivering consistent, predictable performance at a meaningfully lower cost. Hold dotted-line accountability for Part B medical authorization turnaround times (TAT), partnering with the clinical leaders of that team to monitor performance, surface risks early, and remove administrative barriers to on-time decisions.
• Process Reimagination: Map our administrative processes end to end, including auth intake, requests for additional clinical information, facility census checks, member and provider notifications, and member follow-up, and lead their redesign for speed, consistency, and simplicity.
• Technology & AI Leadership: Partner with Product and Engineering to shape the Orinoco roadmap so that process and technology evolve together. Put our integrated AI tools to work to remove manual effort, so our administrative capacity no longer has to grow at the same rate as our membership.
• Build for Measurement: Design processes that are highly measurable and transparent by default. Partner with Data Science to define and monitor the KPIs that matter, including timeliness, cost per authorization, quality, and provider experience, and use them to drive decisions and continuous improvement.
• People & Vendor Leadership: Lead and develop a team that includes approximately 50 onshore UM Administrative Coordinators and their leaders. Manage our offshore vendor partnership, which supports more than 250 administrative team members, holding it to clear performance standards while building a shared culture of ownership and care.
• Provider & Member Experience: Partner with the Provider Network team to understand what providers and facilities need from this process, and build it in. Design every touchpoint, from outreach to notifications to follow-up, with the humans on the other end in mind.
• Cross-Functional Partnership: Work closely with the Senior Director of UM, who owns end-to-end authorization performance, along with the UM Medical Directors, Compliance, Provider Network, Data Science, and Engineering teams to keep the operation aligned and consistently audit-ready.

Required skills and experience:

• Mission & Heart: A genuine commitment to treating members like family, and a belief that operational excellence and empathy belong together.
• Proven Operator at Scale: A track record of leading high-volume operations that deliver consistent SLA performance.
• Builder Mindset: Experience taking a complex, multi-step process apart and leading the build of a simpler, more scalable one, rather than only maintaining what exists. You are naturally curious and ask why a step exists before deciding how to improve it.
• Metrics-Oriented: You build for measurement, are comfortable working deep in the workflows and the data, and use both to drive decisions and hold teams and partners accountable.
• Technology & AI Curiosity: Experience partnering with product and engineering teams, and genuine excitement about using AI-enabled tools to transform how work gets done.
• Vendor Management: Experience managing vendor partners against clear performance and quality standards.
• Communication: Exceptional written and verbal communication skills, with the ability to distill complex problems into actionable updates for leadership and stakeholders.
• Education: Bachelor’s degree required.

Desired skills and experience:

• Healthcare Operations: Experience in payer operations, utilization management, claims, provider revenue cycle, or a similar high-volume healthcare environment. Prior UM experience is not required.
• Medicare Advantage Familiarity: Understanding of Medicare Advantage operations and CMS requirements.
• Advanced Degree: MBA or advanced degree in health administration or finance is a plus.
• MBA or advanced degree in health administration or finance is a plus.

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Salary range: $182,000 - 247,000 / 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.

Founded in 2017, Devoted Health is on a mission to dramatically improve the health and well-being of older Americans by caring for everyone like they are family, and that includes our employees. Our robust and seamlessly integrated care platform merges advanced data and AI access with world-class clinical and service experiences to create a member experience that is unlike the industry norm. To continue building upon our mission, we want to bring together those who share our values, embrace change and advancement, and are enthusiastic about where we're going - all the while bringing their own unique qualities, experiences, and expertise, in hopes of further changing the healthcare experience.

Devoted is an equal opportunity employer. We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoted’s Code of Conduct, our company values and the way we do business.

As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.