[Remote] UM Operations Quality Program Manager at Devoted Health

United States

Apply Now

Not SpecifiedCompensation

N/AExperience Level

N/AJob Type

Not SpecifiedVisa

N/AIndustries

Requirements

Advanced UM expertise
Experience with AI/LLM integration
Data-driven decision-making skills
Ability to manage multiple priorities
Experience leading innovation
Understanding of Regulatory and CMS Regulations
Strong analytical and problem-solving skills
Excellent communication and collaboration skills

Responsibilities

Co-lead design, testing, and implementation of LLM-based tools
Translate clinical workflows into AI-friendly use cases
Track AI performance metrics and escalate risks
Partner with Data Science and Engineering to refine AI tools
Develop training resources for clinical staff on AI/LLM tools
Identify opportunities for automation within audit workflows
Lead the UM quality and audit program
Oversee internal and delegated entity audits
Analyze audit trends and develop action plans
Develop dashboards and executive-level reports
Monitor and respond to high-risk issues
Monitor and analyze operational performance metrics
Lead cross-functional initiatives to streamline UM workflows
Ensure compliance with CMS Regulations and internal policies
Investigate audit discrepancies and AI-identified anomalies

Skills

Devoted Health

Medicare Advantage plans with personalized support

About Devoted Health

Devoted Health provides Medicare Advantage plans aimed at simplifying and making healthcare more affordable for seniors aged 65 and older. Their plans include services like provider and pharmacy searches, prescription drug coverage, and preventive care rewards. Members pay premiums for these plans, and the company may also receive government payments for managing Medicare benefits. What sets Devoted Health apart from competitors is their high level of customer service, featuring Devoted Health Guides who assist members in navigating their healthcare options and addressing common issues with traditional insurance. Additionally, they promote preventive care through the Devoted Dollars program, which rewards members for engaging in health activities. The goal of Devoted Health is to create a more compassionate and accessible healthcare experience for its members.

Waltham, MassachusettsHeadquarters

2017Year Founded

$2,194.5MTotal Funding

SERIES_ECompany Stage

HealthcareIndustries

1,001-5,000Employees

Benefits

Comprehensive health plan

401(k) retirement plan

Generous vacation and holiday time

Lyra mental health resources

Time off to vote

Risks

Increased competition from Medicare Advantage providers like Clover Health and Oscar Health.

Potential regulatory changes affecting Medicare Advantage plans by CMS.

Rising healthcare costs could impact the affordability of Devoted Health's plans.

Differentiation

Devoted Health offers personalized assistance through Devoted Health Guides for member support.

The company emphasizes preventive care with its Devoted Dollars rewards program.

Devoted Health integrates virtual and in-home care with top local providers.

Upsides

Devoted Health raised $287 million in Series E funding in 2024.

The company expanded Medicare Advantage plans to eight new states in 2023.

Devoted Health achieved a 5-star Medicare Advantage rating in Ohio in 2023.

Land your dream remote job 3x faster with AI

Try Jobo Free