Director, Utilization Management Operations

Devoted Health • Waltham, MA

23h • $182,000 - $248,000 • Remote

About The Position

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. At Devoted, our mission is to dramatically improve the health and well-being of our members by treating each of them like family. Core to this mission is ensuring our members receive the right care, at the right time, in the right setting. This is our work, and we are passionate about it because it matters deeply to our members and provider partners. We are seeking a leader to serve as the Director of Utilization Management Operations. This individual will be a cornerstone of our Health Services division, bridging the gap between complex clinical needs and scalable, efficient business processes. You will lead a team of clinicians and coordinators, alongside a critical offshore vendor partnership, to ensure our utilization management processes deliver timely and accurate decisions.

Requirements

• Demonstrated experience leading large clinical teams.
• An understanding of the nuance required when managing clinicians and healthcare workflows is essential.
• A track record of transforming complex operational challenges into scalable business processes in a fast-paced environment.
• A data-driven mindset with the ability to use insights to drive decisions.
• Genuine interest or experience in leveraging AI-enabled tools to optimize clinical workflows.
• 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.

Nice To Haves

• Prior experience in Utilization Management processes and the medical necessity review lifecycle is highly beneficial but not strictly required if clinical leadership experience is strong.
• Familiarity with Medicare Advantage operations and CMS guidelines.
• MBA or advanced degree in health administration or finance is a plus.

Responsibilities

• Provide leadership and professional development to clinical and non-clinical teams.
• Foster a culture of integrity and clinical excellence, ensuring all UM activities align with Devoted’s goal of treating members like family.
• Directly lead a team of Senior Managers and Managers who oversee teams of nurses and intake coordinators.
• Manage our offshore partnership, ensuring their performance metrics and workflows are aligned with department targets.
• Play a key role in evaluating and prioritizing improvement opportunities to ensure our technology supports accurate and efficient workflows.
• Be engaged with our AI tools for process and platform improvement while ensuring strict compliance with our AI Governance and Oversight policies.
• Partner closely with Data Science and Engineering teams to identify key measurement points.
• Develop, implement, and systematically monitor comprehensive KPIs to ensure operational health and decision accuracy.
• Partner with Compliance and Legal teams to ensure the operation is consistently audit-ready.
• Digest complex regulatory guidance (e.g., NCDs, LCDs, Medicare Managed Care Manual) and translate it into compliant, high-quality operational workflows.
• Act as a close partner to the Provider Network team to ensure our 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.

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
• Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles
• Parental leave program
• 401K program

What This Job Offers

• Job Type: Full-time
• Career Level: Director