At Devoted Health, we’re on a mission to dramatically improve the health and well-being of older Americans by caring for every person like family. That’s why we’re gathering smart, diverse, and big-hearted people to create a new kind of all-in-one healthcare company — one that combines compassion, health insurance, clinical care, service, and technology – to deliver a complete and integrated healthcare solution that delivers high quality care that everyone would want for someone they love. Founded in 2017, we’ve grown fast and now serve members across the United States. And we’ve just started. So join us on this mission!
Job Description
A bit about this role:
As a Utilization Management Operations Auditor you’ll have the opportunity to make a difference in the lives of our members. You’ll be responsible for performing regulatory, accreditation and operational audits to document compliance with standards, operational and performance improvement objectives as outlined by Management. Our Utilization Management Operations Auditor is a paragon of hypercompliance committed to integrity and excellence. Our ideal Utilization Management Operations Auditoris a self starter who can lead from beginning to end. They are compassionate,solutions-oriented, and enthusiastic about providing an outstanding experience for Devoted Health’s members.
Responsibilities will include:
Independent worker who has the ability to self initiate.
Lead UM initiatives.
Develop and maintain audit tools used to conduct UM oversight.Examines and compares records and processes with required standards for accuracy and completeness based on currently established regulatory, accreditation and/or operational process improvement project standards.
Assists in the review of new regulatory and accreditation standards on an annual or as needed basis.
Ability to take large volumes of complex information and present it in a clear and concise manner.
Annaylze, summarize & prepare audit findings with appropriate notification to management of issues in a concise and well-documented format. Provide recommendations for improvement and coaching as necessary.
Conducts follow-up reviews to assess and verify effectiveness of any implemented action plans.
Analyzes quality assurance and compliance data and assists in preparing reports.
Assists in designing and implementing solutions to quality management issues.
Maintains a strong working knowledge of state and federal legislation, statutes, and regulations, as well as various client service level agreements.
Other tasks as assigned by the Utilization Management Leadership.
Develops and conducts effective Utilization Management orientation and training programs on operational systems and creates business practices to ensure consistent performance within plan, regulatory and accreditation standards.
Collaborates with management and Utilization Management staff to identify and assess learning needs impacting operational effectiveness.
Creates and conducts effective training programs on operational best practices & clinical training to improve staff morale, member care coordination and operational efficiency.
Assists with the timely development and revision of training materials, manuals, and evaluation materials. Maintains detailed records of training programs and participants and generates accurate statistical reports.
Develops and coordinates the presentation of continuing education activities specific to managed care principles. Prepares materials as needed to specific cases for learning opportunities in managed care principles on real-time cases.
Maintains technical proficiency and remains current with the latest developments, advancements and trends in utilization management compliance.
Attributes to success:
A desire to make a change in the healthcare experience: you love to serve and make a difference
Proven success in building relationships
The ability to prioritize and manage multiple/large projects and responsibilities.
Excellent communication and executive presentation skills with the ability to adjust your tone and approach to different people.
The ability to articulate and break down complex information.
Adaptability and comfort in a dynamic, fast paced environment.
Transparency in your work – what’s going well and what’s not
Team player mentality with a can-do attitude
Ability to work in a fast paced, changing environment
Desired skills and experience:
Independent contributor with lead experience.
Experience in leading projects.
The ability to comfortably multi- task and pivot priorities as needed.
Ability to leverage technology and use data to drive insights and actions. Google Suite experience (a plus)
Experience working with analytical software and understanding how it drives reporting
Strong quantitative and qualitative analysis skills
3+ years in health plan operations (Medicare preferred)
Healthcare experience at a payer working in UM and/or audit operations
Experience in and understanding of leading audits, including modern audit/data-driven approach.
An unrestricted RN or LVN/LPN license (a plus)
Comply with industry specifications, standards, regulations, and laws.
Review operational practices: Documenting compliance related processes, maintaining records, and facilitating interventions.
Salary Range: $64,000 – $66,900
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.