Job Overview
Location
Fully Remote - California
Job Type
Full-time
Category
Software Engineering
Date Posted
June 14, 2026
Full Job Description
đź“‹ Description
- • Lead the Senior Director of Utilization Management (UM) function for Devoted Health, reporting directly to the department head and partnering with UM team leaders to optimize operational workflows.
- • Translate complex regulatory guidance—including NCDs, LCDs, and the Medicare Managed Care Manual—into compliant, scalable, and audit-ready operational processes.
- • Collaborate with cross-functional stakeholders across Clinical, Product, Engineering, and Network teams to drive alignment, implement process improvements, and ensure decision accuracy in medical necessity reviews.
- • Identify and execute opportunities for workflow optimization in UM operations, leveraging data-driven insights and AI-enabled tools to enhance efficiency and member care outcomes.
- • Build and maintain trusted relationships with internal teams and external vendors and provider partners to ensure seamless coordination and accountability in UM processes.
- • Foster a culture of transparency, accountability, and continuous improvement by embedding data-driven decision-making into daily UM operations.
- • Ensure all UM processes are not only compliant with federal and state regulations but also designed for scalability, accuracy, and operational excellence.
- • Drive organizational change through influence and relationship-building, without direct authority, across multiple departments and functional areas.
- • Support the evolution of the medical care journey for older Americans by aligning UM strategies with Devoted’s mission to treat members like family.
- • Participate in semi-annual on-site work at a Devoted office, with travel required despite the fully remote nature of the role.
- • Oversee the end-to-end medical necessity review lifecycle, ensuring adherence to industry standards and internal policies while improving member experience and outcomes.
- • Serve as a strategic operator who transforms complex healthcare operational challenges into efficient, repeatable, and scalable business systems.
- • Communicate complex regulatory and operational issues clearly to leadership and stakeholders through concise, actionable updates in both written and verbal formats.
- • Maintain unwavering commitment to ethical standards and member-centric care, grounded in integrity and a family-first philosophy.
🎯 Requirements
- • Bachelor’s degree required; 10+ years of professional experience in healthcare operations or a related field
- • Demonstrated experience with Utilization Management processes and the medical necessity review lifecycle
- • Deep analytical ability to master and operationalize complex regulatory guidance (e.g., NCDs, LCDs, Medicare Managed Care Manual)
- • Proven track record of transforming complex operational challenges into scalable business processes in a fast-paced healthcare environment
- • Excellent written and verbal communication skills with ability to influence cross-functional stakeholders without direct authority
- • Strong moral compass and unwavering commitment to caring for members like family
🏖️ Benefits
- • Employer-sponsored health, dental, and vision plans with low or no premium
- • Generous paid time off
- • $100 monthly mobile or internet stipend
- • Stock options for all employees
- • Parental leave program
- • 401K program
Skills & Technologies
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About Devoted Health, Inc.
Devoted Health, Inc. operates as a Medicare Advantage health plan provider, offering comprehensive coverage, personalized care navigation, and integrated technology to seniors across the United States. The company combines clinical expertise, data analytics, and member support services to coordinate physician visits, prescription management, and preventive care, aiming to improve health outcomes and reduce unnecessary costs for its members.
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