Utilization Management Senior Director

Job Description 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. A bit about this role: Devoted Health is seeking a strategic and influential leader and proven operator to serve as the Senior Director of Utilization Management (UM). This role is designed for an operator who can navigate complex regulatory guidance and transform it into durable, efficient, and scalable business processes. Reporting directly to the department head, you will partner closely with the UM team leaders to help identify and execute opportunities for optimization across the department. You will lead efforts to ensure our workflows are not only highly compliant and audit-ready but also optimized for decision accuracy and operational efficiency. Your Responsibilities and Impact will include: Process Optimization: Work closely with the UM team leaders and stakeholders across the business to identify and support the execution of process improvements including workflow optimization, medical policy decision support, and technology improvements Regulatory Translation: Digest regulatory guidance/requirements (e.g., NCDs, LCDs, Medicare Managed Care Manual) and translate them into compliant operational workflows Influential Leadership: Drive alignment and change across a broad set of cross-functional stakeholders, including Clinical, Product, Engineering, and Network teams, to achieve goals Stakeholder & Vendor Management: Build credibility and trust with internal teams and external vendors and provider partners Continuous Improvement: Foster a culture of accountability and transparency, utilizing data-driven insights and AI-enabled tools to continuously refine the medical care journey for our members Required skills and experience: Integrity & Trust: A strong moral compass and unwavering commitment to caring for members like family Proven Operator: A track record of transforming complex operational challenges into scalable business processes in a fast-paced environment Influential Communicator: Excellent written and verbal communication skills with the ability to distill complex problems into actionable updates for leadership and stakeholders Strategic Leadership: Demonstrated experience leading teams and driving organizational change through relationship building and influence Regulatory Proficiency: Deeply analytical with the ability to master complex regulatory guidance and incorporate it into daily operations UM Familiarity: Experience with Utilization Management processes and a solid understanding of the medical necessity review lifecycle Education: Bachelor’s degree required; 10+ years of professional experience in healthcare operations or a related field Desired skills and experience: Medicare Advantage Expertise: Prior experience in Medicare Advantage UM operations or Risk Adjustment is highly preferred Advanced Degree: MBA or advanced degree in health administration or finance is a plus Salary range: $182,000-$278,000 annually The pay range listed for this position is the range the organization reasonably and in good faith expects to pay for this position at the time of the posting. 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 will depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job. Our Total Rewards package includes: 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 And more.... *Our total rewards package is for full time employees only. Intern and Contract positions are not eligible. Healthcare equality is at the center of Devoted’s mission to treat our members like family. We are committed to a diverse and vibrant workforce. 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! Devoted is an equal opportunity employer. We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoted’s Code of Conduct, our company values and the way we do business. As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.