3+ years of utilization management or prior authorization experience.
1+ year of prior leadership or supervisory experience required.
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.
Excellent problem-solving and analytical skills.
Experience in a fast-paced, high-volume environment.
Proficiency with healthcare systems, EHRs, and reporting tools.
Experience driving technology-enabled workflow improvements, particularly with AI/LLM tools.
Nice to have
Bachelor’s degree in healthcare operations, business administration, or a related field preferred.
Experience with Intake, authorization, or clinical coordination processes.
Familiarity with UM or case management workflows.
Full description
Job DescriptionA bit about this role:
The Supervisor manages the day-to-day operations of the Utilization Management Coordinators, ensuring timely and accurate processing of prior authorization requests. This role is highly hands-on, focusing on daily execution, immediate problem-solving, staff coaching, and maintaining compliance with all regulatory requirements.
Your Responsibilities and Impact will include:
Team Leadership & Development: Lead, coach, and develop staff, mentoring them on their competencies and career goals while monitoring productivity, accuracy, and performance; Provide operational and administrative support to the team.
Intake & Prior Authorization Oversight: Directly manage daily operations of the Utilization Management Coordinator Team to ensure timely and accurate processing of authorization requests, including triaging and entering incoming PA requests and reaching out to hospitals and provider offices to obtain important clinical documentation; Ensure requests are appropriately entered, documented, and routed for clinical review and determination.
Clinical Coordination Management: Oversee the coordination of clinical reviews and peer-to-peer (P2P) scheduling between providers and Medical Directors, including contacting providers to communicate clinical decisions; Ensure all required documentation is present for clinical review, including managing RFI work and EHR access workflows.
Operational Performance & Compliance: Plan, organize, and coordinate the team's work and initiatives to ensure achievement of specific, measurable goals and deadlines, including meeting service level agreements and regulatory turnaround time requirements; Monitor work queues, daily census checks, and operational metrics; Identify obstacles, problem-solve, and implement changes to enhance workflow efficiency and ensure compliance with CMS, Medicare Advantage, and internal UM policies and procedures.
AI Workflow Ownership: Act as the domain owner for Utilization Management AI workflows for the team, responsible for the full lifecycle, including building, executing, implementing, and monitoring the performance and refinement of AI/LLM-enabled tools; Define and track quality metrics (accuracy, throughput) for AI-enabled processes, interpreting data and making iteration decisions in partnership with AI Enablement Partners ; Ensure local governance and adherence to AI use policies within the team.
Cross-Functional Collaboration: Cultivate and maintain strong partnerships with clinical leadership, provider relations, claims, and other internal teams to support seamless UM operations, including care transition workflows and case follow-up.
Required skills and experience:
3+ years of utilization management or prior authorization experience.
1+ year of prior leadership or supervisory experience required.
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.
Excellent problem-solving and analytical skills.
Experience in a fast-paced, high-volume environment.
Proficiency with healthcare systems, EHRs, and reporting tools.
Experience driving technology-enabled workflow improvements, particularly with AI/LLM tools.
Desired skills and experience:
Bachelor’s degree in healthcare operations, business administration, or a related field preferred.
Experience with Intake, authorization, or clinical coordination processes.
Familiarity with UM or case management workflows.
#LI-Remote
Salary range: $58,000 - $80,000 annually
The pay range listed for this position is the range the organization reasonably and in good faith expects to pay for this position at the time of the posting. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered will depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.
Our Total Rewards package includes:
Employer sponsored health, dental and vision plan with low or no premium
Generous paid time off
$100 monthly mobile or internet stipend
Stock options for all employees
Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles
Parental leave program
401K program
And more....
*Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.
Founded in 2017, Devoted Health is on a mission to dramatically improve the health and well-being of older Americans by caring for everyone like they are family, and that includes our employees. Our robust and seamlessly integrated care platform merges advanced data and AI access with world-class clinical and service experiences to create a member experience that is unlike the industry norm. To continue building upon our mission, we want to bring together those who share our values, embrace change and advancement, and are enthusiastic about where we're going — all the while bringing their own unique qualities, experiences, and expertise, in hopes of further changing the healthcare experience.
Devoted is an equal opportunity employer. We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoted’s Code of Conduct, our company values and the way we do business.
As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.