Remote Utilization Management Supervisor

Devoted Health; United States; On-site; USD 58,000 - 80,000; Full time

Benefits offered by this job

Health plan

Generous PTO

$100 monthly stipend for mobile or not

Stock options

Bonus eligibility

Parental leave

401K

Job summary

Devoted Health is seeking a hands-on Supervisor to lead the Utilization Management Coordinator team, ensuring timely handling of prior authorization requests and maintaining CMS and Medicare Advantage compliance. The role emphasizes coaching, daily execution, and continuous improvement, including AI/LLM workflow ownership.

You'll oversee intake, clinical coordination, and performance metrics, partnering with clinical leadership and claims teams to streamline care transitions and ensure

Qualifications

• 3+ years of utilization management or prior authorization experience.
• 1+ year of prior leadership or supervisory experience required.
• Experience in Medicare Advantage or managed care.
• Knowledge of prior authorization workflows, clinical review processes, and regulatory requirements (e.g., Medicare Advantage).
• Strong organizational, communication, and operational management skills.
• Excellent problem-solving and analytical skills.
• Experience in a fast-paced, high-volume environment.
• Proficiency with healthcare systems, EHRs, and reporting tools.
• Experience driving technology-enabled workflow improvements, particularly with AI/LLM tools.

Responsibilities

• Team Leadership & Development: Lead, coach, and develop staff, mentoring them on their competencies and career goals while monitoring productivity, accuracy, and performance; Provide operational and administrative support to the team.
• Intake & Prior Authorization Oversight: Directly manage daily operations of the Utilization Management Coordinator Team to ensure timely and accurate processing of authorization requests, including triaging and entering incoming PA requests and reaching out to hospitals and provider offices to obtain important clinical documentation; Ensure requests are appropriately entered, documented, and routed for clinical review and determination.
• Clinical Coordination Management: Oversee the coordination of clinical reviews and peer-to-peer (P2P) scheduling between providers and Medical Directors, including contacting providers to communicate clinical decisions; Ensure all required documentation is present for clinical review, including managing RFI work and EHR access workflows.
• Operational Performance & Compliance: Plan, organize, and coordinate the team's work and initiatives to ensure achievement of specific, measurable goals and deadlines, including meeting service level agreements and regulatory turnaround time requirements; Monitor work queues, daily census checks, and operational metrics; Identify obstacles, problem-solve, and implement changes to enhance workflow efficiency and ensure compliance with CMS, Medicare Advantage, and internal UM policies and procedures.
• AI Workflow Ownership: Act as the domain owner for Utilization Management AI workflows for the team, responsible for the full lifecycle, including building, executing, implementing, and monitoring the performance and refinement of AI/LLM-enabled tools; Define and track quality metrics (accuracy, throughput) for AI-enabled processes, interpreting data and making iteration decisions in partnership with AI Enablement Partners ; Ensure local governance and adherence to AI use policies within the team.
• Cross-Functional Collaboration: Cultivate and maintain strong partnerships with clinical leadership, provider relations, claims, and other internal teams to support seamless UM operations, including care transition workflows and case follow-up.

Skills

Utilization management

Leadership experience

Medicare Advantage knowledge

EHRs & reporting tools

AI/LLM tools experience

Regulatory knowledge (CMS)

Communication & organization

Education

Bachelor’s degree preferred

Job description

Devoted Health is seeking a hands-on Supervisor to lead the Utilization Management Coordinator team, ensuring timely handling of prior authorization requests and maintaining CMS and Medicare Advantage compliance. The role emphasizes coaching, daily execution, and continuous improvement, including AI/LLM workflow ownership.

You'll oversee intake, clinical coordination, and performance metrics, partnering with clinical leadership and claims teams to streamline care transitions and ensure