Teams at Devoted Health

Lead regulatory compliance activities for Medicare Advantage operations: track and implement regulatory communications, support audits and reporting, perform exclusion screening and entity management, analyze metrics and APCD data, prepare board materials, and support AI initiatives and cross-functional compliance requests to ensure adherence to federal and state requirements.

Manage day-to-day operations of Utilization Management Coordinators to ensure timely prior authorization processing, triage, documentation, and clinical review coordination. Lead and coach staff, monitor performance and compliance with Medicare Advantage and CMS requirements, own AI/LLM-enabled UM workflows and quality metrics, and collaborate cross-functionally to meet SLAs and improve operational efficiency.

Analyze provider demographics, claims payment and performance data to identify gaps and root causes. Support provider onboarding, conduct audits across provider systems, prepare monthly performance meeting materials, engage with providers to resolve issues, and partner with performance managers to implement process improvements and reporting.