Teams at Devoted Health

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.

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.