Director, Utilization Management Operations

About the Role

The ideal candidate will have a strong clinical background, with experience in managing large teams and driving operational improvements in fast-paced healthcare environments. A data-driven mindset, excellent communication skills, and the ability to distill complex problems into actionable insights are essential for success in this role. Devoted Health is committed to treating its members like family, and this role will play a critical part in ensuring that caregivers receive the support and resources they need to deliver exceptional care.

What You Will Do

• Provide leadership and professional development to clinical and non-clinical teams, fostering a culture of integrity and clinical excellence
• Directly lead a team of Senior Managers and Managers who oversee teams of nurses and intake coordinators
• Manage the offshore partnership, ensuring performance metrics and workflows align with department targets
• Evaluate and prioritize improvement opportunities for the internal technology platform to support accurate and efficient workflows
• Collaborate with Data Science and Engineering teams to identify key measurement points and develop comprehensive KPIs
• Partner with Compliance and Legal teams to ensure the operation is consistently audit-ready and compliant with regulatory guidance
• Act as a close partner to the Provider Network team, ensuring the 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
• Develop, implement, and systematically monitor comprehensive KPIs to ensure operational health and decision accuracy
• Digest complex regulatory guidance and translate it into compliant, high-quality operational workflows

What We Are Looking For

• Demonstrated experience leading large clinical teams, with a strong understanding of healthcare workflows and operations
• A data-driven mindset, with the ability to use insights to drive decisions and improve operational efficiency
• 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
• Experience in Utilization Management processes and the medical necessity review lifecycle is highly beneficial
• Familiarity with Medicare Advantage operations and CMS guidelines
• MBA or advanced degree in health administration or finance is desirable
• A genuine interest or experience in leveraging AI-enabled tools to optimize clinical workflows
• Ability to work in a fast-paced environment, with a track record of transforming complex operational challenges into scalable business processes

Nice to Have

• Prior experience in a similar director-level role, with a proven track record of driving transformation and improvement in healthcare operations
• Experience with technology platforms and AI tools, with a strong understanding of their application in clinical workflows
• Familiarity with Devoted Health's specific technology platform and workflows
• A background in nursing or a related clinical field, with a deep understanding of patient care and clinical decision-making

Benefits and Perks

• Competitive salary and benefits package, with a focus on supporting the well-being and growth of our team members
• Opportunity to work with a dynamic and innovative company, committed to improving the health and well-being of its members
• Flexible working arrangements, with the option to work remotely and collaborate with a distributed team
• Access to cutting-edge technology and AI tools, with opportunities for professional development and growth
• Comprehensive health insurance and wellness programs, with a focus on supporting the physical and mental health of our team members
• Generous PTO and holiday policy, with opportunities for rest and relaxation
• Retirement savings plan and other financial benefits, with a focus on supporting the long-term financial well-being of our team members
• Professional development opportunities, with a focus on supporting the growth and development of our team members

• Ensure your resume and cover letter highlight your experience in managing clinical teams and driving operational improvements in healthcare environments.
• Be prepared to discuss your experience with AI-enabled tools and technology platforms, and how you have applied them to optimize clinical workflows.
• Develop a strong understanding of Devoted Health's mission and values, and be prepared to discuss how your experience and skills align with the company's goals.
• Practice your communication skills, and be prepared to distill complex problems into actionable insights for leadership.
• Research the current healthcare landscape and trends in utilization management, and be prepared to discuss how you would drive transformation and improvement in this area.
• Consider creating a portfolio or examples of your work, showcasing your ability to lead teams and drive operational improvements in healthcare environments.
• Be prepared to negotiate salary and benefits, and have a clear understanding of your worth and the market rate for similar roles.