Jobs at Devoted Health

Performs complex utilization management, appeals, claims, provider dispute, and quality-of-care reviews requiring advanced nursing judgment. Applies InterQual criteria, CMS requirements, Medicare Advantage regulations, medical policies, and benefit guidelines to make and document medical necessity determinations. Analyzes workflow trends, improves policies and processes, supports compliance and audit readiness, and provides clinical expertise, coaching, and escalation support across operational teams.

Manages clinical data acquisition across health plans and medical teams. Analyzes data gaps, develops execution plans, implements integrations with HIEs, labs, EHRs, and aggregators, and ensures data quality and usability. Oversees vendor relationships, interoperability strategies, AI-enabled processes, and KPIs while coordinating internal stakeholders and external partners.

Leads AI performance and quality operations across frontline voice and chat agents. Builds AI-powered interaction monitoring, evaluation, coaching, visualization, and feedback systems that improve member experience and team performance. Partners with frontline leaders to drive adoption, scale successful frameworks, and oversee operators and agent builders. Requires strong data fluency, systems thinking, communication, people leadership, and hands-on familiarity with modern AI tools.

Build and deploy paid digital marketing campaigns across Meta, YouTube, Search, and other channels. Coordinate with ad vendors and creative teams, ensure compliant and error-free materials, manage creative requests, and track channel performance using Looker and Google Sheets. The role requires campaign optimization, marketing measurement, strong organization, problem-solving, adaptability, and cross-functional collaboration in a regulated industry.

Leads cost accounting policies, allocation methodologies, profitability analysis, intercompany reporting, financial modeling, monthly close activities, variance analysis, business cases, and ROI reviews. Partners cross-functionally to improve processes, controls, reporting tools, and cost performance. Supports audits and regulatory inquiries while educating operational teams on financial results. Requires substantial cost accounting and FP&A experience, advanced modeling skills, and familiarity with ERP, planning, or BI systems.

Conduct high-volume outbound calls to help members overcome medication access and adherence barriers. Build trust, identify needs, enroll members in pharmacy and support programs, resolve issues with providers and pharmacies, research answers using internal and AI-assisted tools, document interactions, and manage follow-up through resolution while meeting performance goals.

Conduct high-volume outbound calls with English- and Spanish-speaking members to support medication adherence, enroll them in pharmacy and care programs, identify barriers, resolve issues, and coordinate with providers, pharmacies, and clinical teams. Document interactions, manage follow-ups, use internal and AI-assisted tools, and meet performance goals in a fast-paced environment.

Identify, engage, and contract healthcare providers to build and maintain a Medicare Advantage network within a geographic region. Manage outreach, negotiate and execute standard agreements, track documentation and workflows, collaborate with Legal, Credentialing, Finance and Market teams, use data to support negotiations, and drive process improvements to meet network adequacy and growth goals.

Oversee Special Needs Plan operations, regulatory compliance, Model of Care development, CMS and Medicaid requirements, documentation, reporting, and audit readiness. Translate changing regulations into workflows, improve operational processes, develop Medicaid benefit expertise, and collaborate cross-functionally to ensure accurate compliance and effective support for frontline teams and members.

Oversee claims benefit configuration, including setup, analysis, mapping, testing, auditing, troubleshooting, and implementation. Maintain accurate member cost sharing, benefit limitations, provider payment information, authorization rules, and denial-code mappings. Lead annual benefit readiness and BID application management, coordinate cross-functional teams, manage configuration inquiries, enforce quality controls, and implement process improvements to reduce errors and improve operational efficiency.

Leads provider data accuracy and directory compliance for a health plan, including validation, verification, remediation, CMS requirements, audit readiness, metrics, and regulatory responses. Manages and scales onshore and offshore teams, improves risk-based verification infrastructure, partners with product and engineering on automation and directory strategy, supports care navigation, and oversees vendors. Translates provider data insights into operational improvements, measurable quality outcomes, and executive reporting.

Manage pharmacy informatics for Orinoco EHR, serving as the medication-related subject matter expert. Oversee e-prescribing integrations with Surescripts and Medi-Span, medication mapping, regulatory compliance, clinical workflow design, system integration testing, certifications, and patient-safety optimization. Partner with clinical, engineering, and integration teams to improve medication documentation, prescribing, monitoring, and organizational adoption of best practices.

Lead product strategy and roadmap execution for healthcare initiatives, driving measurable outcomes in cost reduction, clinical quality, service experience, retention, and team efficiency. Partner with Clinical, Operations, Data Analytics, Engineering, and Compliance teams; communicate product insights to senior stakeholders; and serve as the subject matter expert for digital service delivery. The role requires strong software product management experience, healthcare expertise, data-driven decision-making, and the ability to ship consumer, practitioner, and AI-enabled products.

Owns the quality assurance program for retrospective coding and auditing operations, including policies, sampling, reviewer oversight, vendor management, escalated chart reviews, scorecards, remediation, and coding education. The role requires expertise in ICD-10-CM, risk adjustment, medical record abstraction, and compliance. It also partners with technology and analytics teams to validate AI-assisted coding tools, monitor production performance, and improve coding accuracy across internal and offshore teams.

Manage day-to-day administration of employee health, welfare, retirement, and wellness benefits. Support employee inquiries, qualifying life events, eligibility verification, HRIS and payroll integrations, benefit communications, onboarding, open enrollment, system testing, vendor coordination, and process improvement. The role requires translating complex benefits information into accessible communications and presentations while partnering with HR, payroll, HRIS, consultants, and vendors.

Leads daily operations and long-term strategy for inbound correspondence and outbound print production. Oversees operating models, capacity planning, reporting, tooling, compliance, audits, vendor performance, budgets, and cross-functional partnerships across health plan functions. Builds scalable workflows, dashboards, scorecards, and monitoring processes while ensuring regulatory requirements, document accuracy, timeliness, accessibility, and retention standards are met.

Research and resolve complex retroactive Medicare enrollment and payment corrections using CMS guidance and applicable regulations. Submit MARx, MAPD Help Desk, and eRPT transactions; monitor aging, risks, trends, and capacity; coordinate claims, pharmacy, billing, subsidy, notification, and ID-card remediation. Build repeatable operational tooling, maintain audit-ready case records, analyze root causes, and collaborate with Enrollment, Compliance, Product, Engineering, and other stakeholders.

Prepare monthly, quarterly, and annual statutory financial statements and supplemental filings for NAIC and state regulators. Support insurance audits, reconciliations, filing submissions, reporting-system testing, and reinsurance accounting initiatives. Review filings, lead ad hoc finance projects, improve processes, maintain documentation, and meet strict reporting deadlines in a fast-paced environment.

The Senior Treasury Manager leads cash management, liquidity forecasting, international and multi-currency banking, debt and covenant compliance, capital flows, investments, treasury controls, audits, and policy administration. The role owns Kyriba, manages banking and payments relationships, supports regulated and commercial entities, and partners across Finance, Legal, Tax, Accounting, Compliance, and clinical organizations. Initially an individual contributor, this position may develop and manage a team as the treasury function expands.

Own pharmacy benefits strategy for a commercial book of business, including PBM relationships, contracting, audits, trend analytics, savings initiatives, formulary and utilization management, specialty-drug strategy, and implementations. Lead cross-functional coordination with Finance, Legal, Clinical, Data, vendors, and clients. Oversee ERISA fiduciary processes, CAA/RxDC transparency compliance, member experience, forecasting, and reconciliation of projected versus realized savings.