Utilization Management Lead — AI-Driven Operations

Devoted Health; Oregon; Hybrid; USD 58,000 - 80,000; Full time

Benefits offered by this job

Health insurance

Paid time off

Mobile stipend

Stock options

Job summary

Devoted Health is seeking a Supervisor to lead the Utilization Management Coordinators, directing daily operations, coaching staff, and ensuring timely prior authorization processing. The role focuses on practical execution, problem-solving, and adherence to CMS, Medicare Advantage, and internal policies.

You will oversee clinical coordination, P2P scheduling between providers and Medical Directors, and the governance of AI-enabled workflows, while collaborating with clinical leadership and

Qualifications

• 3+ years of utilization management or prior authorization experience.
• 1+ year of prior leadership or supervisory experience.
• 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.
• Experience driving technology-enabled workflow improvements, particularly with AI/LLM tools.

Responsibilities

• Lead, coach, and develop staff, mentoring them on competencies and career goals while monitoring productivity, accuracy, and performance; provide operational and administrative support.
• Directly manage daily operations of the Utilization Management Coordinator Team to ensure timely processing of authorization requests and obtain clinical documentation from hospitals/providers.
• Oversee coordination of clinical reviews and peer-to-peer scheduling between providers and Medical Directors; ensure documentation for clinical review.
• Plan, organize, and coordinate the team's work to meet service levels and regulatory turnaround times; monitor queues and metrics; drive workflow efficiency and compliance.
• Act as domain owner for Utilization Management AI workflows; build, execute, implement and monitor AI-enabled tools; define quality metrics and governance.
• Cultivate partnerships with clinical leadership, provider relations, claims, and other internal teams to support seamless UM operations.

Skills

Utilization management

Leadership

Medicare Advantage

EHR systems

AI/LLM tools

Regulatory compliance

Process improvement

Data reporting

Education

Bachelor's degree in healthcare operations

Job description

Devoted Health is seeking a Supervisor to lead the Utilization Management Coordinators, directing daily operations, coaching staff, and ensuring timely prior authorization processing. The role focuses on practical execution, problem-solving, and adherence to CMS, Medicare Advantage, and internal policies.

You will oversee clinical coordination, P2P scheduling between providers and Medical Directors, and the governance of AI-enabled workflows, while collaborating with clinical leadership and