Jobs at Devoted Health

Conduct utilization reviews for inpatient, behavioral health, and post-acute services, evaluating medical necessity, level of care, treatment plans, and length of stay under CMS and Medicare Advantage requirements. Review medical records, document determinations, escalate cases to Medical Directors, prepare clinical summaries, coordinate peer-to-peer discussions, and support authorization decisions and regulatory compliance.

Conduct outpatient utilization reviews and prior authorization determinations using medical necessity criteria, CMS and Medicare Advantage requirements, and health plan policies. Review procedures, imaging, therapy, DME, and home health requests; recommend appropriate care settings; escalate cases for physician review; communicate with providers; meet turnaround standards; maintain compliant documentation; and identify quality or risk issues.

Owns member engagement campaigns across multiple communication channels from intake through post-launch analysis. Responsibilities include campaign scoping, journey design, testing, QA, contact governance, compliance and translation review, performance reporting, workflow management, and process improvement. Partners with clinical, quality, product, and technology teams, mentors an operations associate, maintains automated campaigns, and applies AI to repetitive work. The role requires experience in health program engagement, project or communications operations, experimentation, campaign design, and project management systems.

Investigates escalated and complex sales and marketing compliance cases, recommends corrective actions, drafts policies and investigative guidance, presents findings, mentors analysts, conducts quality reviews, identifies compliance trends, and partners with Sales, Legal, Operations, and Technology to improve workflows. The role focuses on Medicare Advantage compliance, agent and agency investigations, audits, remediation, and process improvement.

Manages Medicare Advantage eligibility and enrollment operations across HMO, PPO, and SNP products. Leads enrollment associates, oversees CMS MARx transactions, reconciliations, audits, quality controls, workflow capacity, and regulatory compliance. Resolves complex discrepancies, translates CMS guidance into procedures, drives process improvements and automation, monitors operational metrics, and partners cross-functionally on member-impacting issues and AI-assisted transaction processing.

Manages pharmacy fraud, waste, and abuse investigations and the CVS PBM relationship. Validates and reconciles pharmacy claims, provider, eligibility, prior authorization, and external data to identify discrepancies and fraud indicators. Uses AI/ML detection tools, develops investigative referrals, reviews vendor performance and reporting, maintains audit-ready case records, and presents findings to leadership, legal, regulators, or law enforcement. Partners with compliance, claims, pharmacy, clinical, and data teams while mentoring junior analysts and improving SIU processes.

Leads cost accounting policies, allocation methodologies, profitability analysis, financial modeling, budgeting, forecasting, month-end close, variance analysis, and management reporting. Builds business cases and ROI analyses, supports intercompany accounting and compliance inquiries, and improves financial processes through scalable technology and self-service reporting. Partners with operational teams to improve cost performance and standardize controls.

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.

Process bi-weekly, full-cycle payroll in Workday; manage multi-state tax compliance, garnishments, adjustments, off-cycle payments, and payroll reporting. Reconcile salary and benefit expenses, maintain payroll data integrity, validate timesheets and employee changes, support audits, establish tax jurisdictions, answer employee questions, and train offshore payroll team members.

Owns end-to-end CMS healthcare data and medical record submissions, including file preparation, validation, quality assurance, portal uploads, issue triage, tracking, and compliance documentation. Coordinates submission work, partners with IT and technical teams to resolve system issues, manages secure file transfers, reports metrics and error trends, and maintains standard operating procedures. Supports CMS RADV and Part C improper payment audits while ensuring accurate, timely, and compliant submissions.

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.

Lead Devoted Health’s multi-year interoperability strategy, regulatory compliance, data exchange operations, telephony, vendor partnerships, and external relationships. Build and scale cross-functional teams spanning clinical, operations, engineering, data, legal, and compliance. Drive FHIR/API-based initiatives, health information exchange, and EHR, clinical, claims, and pharmacy integrations while translating complex standards and regulations into executive decisions and measurable improvements in care quality, operational efficiency, and data reliability.

Lead end-to-end operational and financial audits, including risk assessment, planning, testing, documentation, issue development, and reporting. Review audit workpapers, coach internal and co-sourced auditors, support QAIP readiness, contribute to the annual audit plan, and build stakeholder relationships. Apply data analytics, AI, and agile techniques to improve audit quality and efficiency while ensuring compliance with IIA standards and internal methodology.

Lead cross-functional initiatives for agency onboarding, compliance analysis, and partnership enhancements. Scope, plan, and drive projects to implementation using JIRA and Looker, design scalable processes, manage risks and reporting, and support relationship management for top agency partners while ensuring compliance and operational efficiency.

Design and manage the full lifecycle of payment integrity edits and audits, converting CMS, AMA/CPT, and coding regulations into rule logic. Validate hypotheses using data queries, author technical specifications, optimize post-release performance, adopt LLM/AI workflows, map regulatory policy, and coordinate cross-functionally to ensure defensible, efficient claims processing.

Lead clinical pharmacy strategy and execution for Medicare Advantage and Part D Stars measures. Own performance forecasting, measure readiness, regulatory interpretation, cross-functional vendor collaboration (including PBM), and implementation of interventions to drive 5-Star outcomes. Build trackers, set OKRs, audit outreach effectiveness, and represent pharmacy quality in executive forums.

The Senior Manager, AI Performance & Operations is responsible for the performance and improvement of AI workflows, incident response, designing evaluation systems, and stakeholder communication.

Provide telephonic and virtual social work case management for high‑needs patients: assess social determinants, develop personalized care plans, coordinate community and clinical resources, support caregivers, facilitate advanced care and palliative/hospice planning, and collaborate with an interdisciplinary team to improve outcomes.