Utilization Management: Program Design & Insights Senior Manager

At Devoted Health, we’re on a mission to dramatically improve the health and well-being of older Americans by caring for every person like family. That’s why we’re gathering smart, diverse, and big-hearted people to create a new kind of all-in-one healthcare company — one that combines compassion, health insurance, clinical care, service, and technology - to deliver a complete and integrated healthcare solution that delivers high quality care that everyone would want for someone they love. Founded in 2017, we've grown fast and now serve members across the United States.  And we've just started. So join us on this mission!

Job Description

A bit about this role: 

The Utilization Management (UM) Program Design and Insights Senior Manager drives the design and ongoing refinement of Devoted’s best-in-class UM Program, a program designed to enable members to quickly and safely get the care they need at the right time, in the right place.  This role partners with UM leadership, Data Science, Business Intelligence, and Medical Economics to improve forecasting of UM program design impact and improve the monitoring thereof.  This role liaises with UM leadership to assure organizational understanding of the linkages between operations and outcomes and to refine operational workflows, KPIs, and targets accordingly.  This role proactively surfaces opportunities and engages in cross-functional discussions accordingly to pursue non-UM levers to reduce inappropriate care including (e.g., Payment Integrity, provider engagement, network sculpting).  This role is responsible for driving organizational understanding of the impact of the team’s work to inform a data-driven program design.

The ideal candidate is a self-starter who can effectively and proactively analyze data, establish and monitor KPIs for program effectiveness, build relationships with internal and external stakeholders, and consistently strive for improved outcomes.

Your Responsibilities and Impact will include:

• Drive innovative and relevant UM program design and strategy, accounting for historical results and intel from evolving regulatory and industry landscape

• Set, monitor, and as relevant evolve KPIs to measure UM program effectiveness 

• Deepen organizational understanding and forecasting, in partnership with Medical Economics and Data teams, of the downstream impact of UM operations 

• Partner with UM leadership to review opportunities for improved operational excellence 

• Perform frequent, extensive analysis of results to inform program design decisions

• Proactively identify opportunities for new or refined UM policies 

• Proactively identify non-UM opportunities to reduce inappropriate care

• Effectively frame, facilitate, and drive decision making in discussions with cross-functional and executive leadership
   

Required skills and experience:

• Bachelor's Degree or equivalent experience

• Analytic, problem-oriented mindset with comfort and ability to effectively deal with ambiguity

• High degree of influence and exceptional stakeholder engagement skills

• 5+ years of experience influencing and driving change in a highly-matrixed organization 

• Cross-functional project management and facilitation proficiency

• Strong written and oral communication skills and high degree of professionalism

Desired skills and experience:

• Thrives in high-speed environment in a role with a high degree of ambiguity 

• Results-oriented with a willingness to take initiative and get the job done

• 5+ years of Medicare Advantage operations experience and familiarity with UM operations (and/or a willingness to learn and ability to do so quickly and effectively)

• Ability to cultivate positive energy and maintain positive working relationships across Devoted teams and external partners

Salary range: $104,500 - $154,600 annually

Our ranges are purposefully broad to allow for growth within the role over time. 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 may depend on a variety of factors, including the qualifications of the individual appli