Teams 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.

Leads Payment Integrity business operations by monitoring turnaround times, queue health, backlogs, SLAs, quality, and productivity. Designs and launches scalable workflows, manages change and training, tracks KPIs, coordinates vendors and cross-functional teams, integrates AI agents, and resolves operational blockers. Drives continuous improvement, operational performance, escalation management, and measurable business outcomes in a healthcare technology environment.

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.