A bit about us:

Devoted Health is a new health care company looking to improve the lives of seniors in America. We are guided by a deep belief that every senior should be treated like we would treat a member of our own family: with loving care and a profound commitment to their health and well-being. With aging demographics and rising health costs, this is an industry and problem space that needs today’s best talent working on solutions with high integrity and a long term view. We will improve the lives of seniors by helping them navigate the healthcare system, by utilizing world-class technology and data to enable a simplified experience, by partnering with top providers for better health outcomes. We are building a stellar team to drive towards our starting point goal to launch a Medicare Advantage plan and clinical services in 2019.

Why Devoted:

Make a difference... a big difference. You will have the opportunity, in a unique and dynamic culture, to be a part of something incredibly meaningful. We’re a disruptive startup with an inspiring mission. Learn and grow alongside our world-class team of healthcare, technology, and data leaders, dedicated to building a health plan and clinical services that care for everyone like they were our own mothers or fathers. Our team and board members have decades of experience in health policy, clinical services, data and technology. With their support, we look forward to building a health plan and clinical services that will give seniors easy access to the high-quality care they deserve.

A bit more about this role:

Our Manager of Utilization Management will be responsible for key outcomes assuring the operational excellence, compliance, and financial stewardship of our utilization management operations. As a key leader on our clinical team, you will help build our utilization management operation from the ground up. Early on, this will include working with Devoted physicians and benefit design team as well as provider groups in our market to determine which services should require UM and what the criteria should be. It will also include setting up the UM processes and operations, providing direction on workflows and new hiring. As we go live, you will lead the day-to-day operations where the focus will be on ensuring the best possible care for our members. Iterative continuous learning to improve our process using both informal learning from team members as well as a highly data-driven approach will be a major component of this role. You will interface regularly with the claims team and the member service team, and are likely to play a key role in care management as well.

A day at Devoted could include:

• Providing leadership, coaching, and development to a team of nurses performing utilization management
• Deciding which services should require a prior authorization and the clinical criteria on which the prior authorization should be based
• Directing the daily activities of external and internal partners and team members to continually improves the claims process, including turn around time and accuracy
• Providing direction and support to address escalated partner and member challenges
• Developing and maintaining strong relationships with our provider partners Identifying processing inefficiencies and creating and implementing process improvement
• Developing ongoing reporting and analysis to measure the productivity of the utilization management department
• Managing vendor relationships with our UM vendor (likely TruCare) and Interqual
• Managing delegated UM
• Serving as the subject matter expert for utilization management
• Counseling team members on CMS guidelines and MA regulations and to assure compliance
• Assuring utilization management is functioning to achieve member satisfaction and provider satisfaction

Attributes to success:

• Client focused
• Ability to work in an evolving start up
• Organized, ability to manage a queue
• Desire to innovate and improve processes
• Strong analytic and strategic planning skills
• Proven success within highly regulated industry

Skills and experience:

• Registered Nurse with unrestricted license
• 3 years of experience doing utilization management at a health plan
• Experience in managing a team
• Provider clinical experience
• Proven leadership, agility, and collaboration skills
• Understanding of CMS guidelines and MA requirements

If you love running towards complex challenges and transforming them into solutions, if you want to make a potentially huge impact on many lives, and if you are looking to build something from the ground up in a disruptive startup with an inspiring and talented team, Devoted Health may be the place for you.