Utilization Management: Program Design & Insights Senior Manager

United States

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Not SpecifiedCompensation

Senior (5 to 8 years), Expert & Leadership (9+ years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, Health InsuranceIndustries

Requirements

Candidates must possess a Bachelor's degree or equivalent experience, an analytic and problem-oriented mindset comfortable with ambiguity, and strong stakeholder engagement skills. A minimum of 5 years of experience influencing change in a matrixed organization, proficiency in cross-functional project management and facilitation, and excellent written and oral communication skills are required. Experience in Medicare Advantage operations and UM operations is desired.

Responsibilities

The Utilization Management Program Design and Insights Senior Manager will drive the design and refinement of the UM program, partner with various teams to improve forecasting and monitoring of program impact, and refine operational workflows, KPIs, and targets. This role involves proactively identifying opportunities to reduce inappropriate care through UM and non-UM levers, driving organizational understanding of the team's impact, and setting and monitoring KPIs for UM program effectiveness.

Skills

Utilization Management

Program Design

Data Analysis

KPI Monitoring

Stakeholder Management

Business Intelligence

Medical Economics

Healthcare Operations

Forecasting

Data-Driven Program Design

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.

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