[Hiring] Supervisor, Utilization Management Support @Devoted Health

Role Description

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.

• 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.
  • Triaging and entering incoming PA requests.
  • 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.
  • Contact 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.
  • 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.
  • Interpret data and make 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.
  • Support care transition workflows and case follow-up.

Qualifications

• 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.

Requirements

• 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.

Benefits

• 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....