Utilization Management Senior Director

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: 

Devoted Health is seeking a strategic and influential leader and proven operator to serve as the Senior Director of Utilization Management (UM). This role is designed for an operator who can navigate complex regulatory guidance and transform it into durable, efficient, and scalable business processes.

Reporting directly to the department head, you will partner closely with the UM team leaders to help identify and execute opportunities for optimization across the department. You will lead efforts to ensure our workflows are not only highly compliant and audit-ready but also optimized for decision accuracy and operational efficiency.

Your Responsibilities and Impact will include:

• Process Optimization: Work closely with the UM team leaders and stakeholders across the business to identify and support the execution of process improvements including workflow optimization, medical policy decision support, and technology improvements

• Regulatory Translation: Digest regulatory guidance/requirements (e.g., NCDs, LCDs, Medicare Managed Care Manual) and translate them into compliant operational workflows

• Influential Leadership: Drive alignment and change across a broad set of cross-functional stakeholders, including Clinical, Product, Engineering, and Network teams, to achieve goals

• Stakeholder & Vendor Management: Build credibility and trust with internal teams and external vendors and provider partners

• Continuous Improvement: Foster a culture of accountability and transparency, utilizing data-driven insights and AI-enabled tools to continuously refine the medical care journey for our members

Required skills and experience: 

• Integrity & Trust: A strong moral compass and unwavering commitment to caring for members like family

• Proven Operator: A track record of transforming complex operational challenges into scalable business processes in a fast-paced environment

• Influential Communicator: Excellent written and verbal communication skills with the ability to distill complex problems into actionable updates for leadership and stakeholders

• Strategic Leadership: Demonstrated experience leading teams and driving organizational change through relationship building and influence

• Regulatory Proficiency: Deeply analytical with the ability to master complex regulatory guidance and incorporate it into daily operations

• UM Familiarity: Experience with Utilization Management processes and a solid understanding of the medical necessity review lifecycle

• Education: Bachelor’s degree required; 10+ years of professional experience in healthcare operations or a related field

Desired skills and experience:

• Medicare Advantage Expertise: Prior experience in Medicare Advantage UM operations or Risk Adjustment is highly preferred

• Advanced Degree: MBA or advanced degree in health administration or finance is a plus

Salary range: $182,000-$278,000 annually

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....

*Ou