RN UM Operations Clinical Auditor & Education Lead

Devoted Health Services, Inc; Waltham (MA); On-site; USD 82,000 - 96,000; Full time

Benefits offered by this job

Health, dental and vision insurance

Paid time off

$100 monthly stipend for mobile/intern

Stock options for all employees

Bonus eligibility for most roles

Parental leave program

401K program

Job summary

Devoted Health Services, Inc. is seeking an UM Operations Clinical Guide to oversee clinical audits and monitoring within Utilization Management. The role ensures CMS alignment, regulatory compliance, and data-driven improvements while serving as a clinical education resource for the team.

You will lead audit activities, support new-hire OJT, and collaborate with UM Leadership, Medical Directors, Compliance, Quality and other stakeholders to promote accurate, compliant UM practices.

Qualifications

• Active RN license in good standing.
• Clinical nursing experience in Utilization Management or related field.
• Experience reviewing clinical documentation and applying clinical criteria.
• Knowledge of Medicare Advantage/CMS requirements.
• Experience conducting clinical audits and quality reviews.
• Strong analytical and communication skills with attention to detail.
• Ability to work independently and manage multiple audit/training deadlines.

Responsibilities

• Conduct ongoing Clinical Review audits and monitoring for the assigned UM team.
• Ensure audits align with CMS, regulatory, contractual requirements and UM processes.
• Identify trends, root causes and opportunities for process improvement.
• Support staff education, OJT, and targeted re-education based on findings.
• Partner with leaders to implement corrective actions and monitor outcomes.
• Contribute to development of audit tools and readiness for audits.

Skills

RN license

UM clinical nursing

CMS/Medicare Advantage knowledge

Clinical documentation review

Audit/quality review

Data interpretation & trend analysis

Cross-functional collaboration

Deadline management

Tools

Audit tools

Job description

Devoted Health Services, Inc. is seeking an UM Operations Clinical Guide to oversee clinical audits and monitoring within Utilization Management. The role ensures CMS alignment, regulatory compliance, and data-driven improvements while serving as a clinical education resource for the team.

You will lead audit activities, support new-hire OJT, and collaborate with UM Leadership, Medical Directors, Compliance, Quality and other stakeholders to promote accurate, compliant UM practices.