Devoted Health

Manager

• Lead, coach, and develop a team of Digital Care Coordinators and future supervisors or leads
• Build a service-oriented culture focused on supportive member interactions
• Handle goal setting, performance management, career coaching, and leadership development
• Own daily performance of the MyDevoted inbound chat queue, including response times, resolution rates, backlog, and member experience
• Monitor real-time queue health and adjust staffing and priorities to meet service levels
• Ensure member needs are escalated or handed off appropriately to care coordinators, nurse case managers, clinicians, and other teams
• Support volume forecasts, capacity models, and staffing plans
• Develop, track, and report on operational KPIs and turn trends into action plans
• Use data to identify root causes of recurring member needs and recommend upstream fixes
• Design, document, and refine workflows, macros, and escalation protocols
• Partner with product and technology teams to improve MyDevoted chat tooling, including automation and AI-assisted opportunities
• Pilot new initiatives within the innovation hub and scale what works
• Run quality reviews and chat audits to ensure accurate, compliant, and empathetic communication
• Ensure team practices meet regulatory, privacy (HIPAA), and Medicare requirements
• Develop and maintain training and onboarding for new team members
• Collaborate with clinical, member services, care coordination, and operations leaders to align goals and remove member blockers

Manager, Digital Care Coordination

Nurse

• Perform complex clinical reviews across pre-service, concurrent, post-service, claims-related, and escalated cases
• Review standard, expedited, and post-service appeals and provide clear clinical recommendations
• Perform clinical reviews related to claims adjudication, high-priority or high-cost claims, provider disputes, and other cases requiring clinical interpretation
• Evaluate potential Quality of Care concerns and provide clinical summaries and recommendations
• Interpret and apply InterQual, CMS requirements, Medicare Advantage requirements, internal policies, medical policies, benefit requirements, and other clinical decision-support criteria
• Document clinical determinations and recommendations, including services, procedure codes, levels of care, or dates of service approved or denied
• Analyze trends across claims, appeals, clinical escalations, provider disputes, and utilization management workflows
• Partner with cross-functional teams to identify systemic issues and recommend process improvements
• Develop, review, and maintain Utilization Management policies, procedures, clinical workflows, position statements, and decision-support guidance
• Research emerging medical technologies, procedures, and treatments
• Serve as a clinical subject matter expert and escalation resource, providing education, coaching, and guidance to clinical staff
• Support quality assurance, CMS and Medicare Advantage compliance, accreditation and audit readiness, special clinical initiatives, workflow optimization, automation, and operational improvement efforts
• Participate in rotating Saturday coverage approximately once every 2–3 months and occasional holidays

Clinical Nurse Specialist

Clinical Research

• Develop deep understanding of clinical data needs, including medical records, lab results, and ADT, and data usability requirements across Devoted Health Plans and Devoted Medical
• Collaborate and align on outcomes with external partners and internal teams including Network Management, Risk Adjustment, Stars, Devoted Medical, Payment Integrity, and others
• Analyze clinical data availability across geographical areas to identify data gaps, causes, and opportunities to obtain data
• Define an execution plan to ensure broad clinical data coverage in markets and usability by stakeholder teams
• Implement technical integrations with Health Information Exchanges, Labs, Electronic Health Record systems, data aggregators, and other clinical data sources
• Ensure quality of received clinical data
• Explore new frameworks, optimize connections, and evaluate vendor relationships to scale data exchange, improve data quality, and minimize data gaps
• Apply new processes and methodologies using AI to ensure clinical data is consistently available and usable
• Define, implement, and drive KPIs to measure success

Manager, Clinical Data Acquisition

Artificial Intelligence

• Embed with frontline teams and leaders to understand quality standards, interaction breakdowns, and current coaching practices
• Own the performance of high-volume frontline AI agents across voice and chat
• Continue building AI agents to drive higher performance
• Build AI-powered quality monitoring systems for millions of member interactions in real time
• Evaluate interactions beyond pass/fail scoring for member experience, safety, and outcomes
• Build coaching workflows that provide immediate actionable feedback to leaders
• Visualize interaction data, evaluation criteria, coaching signals, and performance trends
• Scale successful systems into reusable frameworks for new teams, interaction types, and channels
• Partner with frontline leaders to drive tool adoption and iterate based on feedback
• Oversee a small team of operators and agent builders driving performance across frontline agents and teams

Senior Manager, AI Performance & Operations

Associate

• Lead the organization's operational execution of member claim processing for the Medicare Advantage business
• Own day-to-day member claim processing, including personally completing complex, escalated, and non-standard claims
• Monitor queue inventory, aging, and turnaround time against service level requirements
• Clear bottlenecks before they become compliance risks and escalate risks to the manager
• Adhere to SOPs and escalate complex scenarios requiring clarification
• Partner with Claims Operations, Configuration, and Tech leadership to identify root causes of processing errors and rework
• Help prevent processing defects through feedback loops
• Support processing member claim appeals and member claim cases

Senior Associate, Member Claim Processing

Digital Marketing

• Build and deploy digital marketing campaigns across multiple channels such as Meta, YouTube, Search, and more
• Coordinate with external ad vendors
• Collaborate with the creative team to produce marketing materials that advance the Devoted brand and generate successful results
• Ensure 100% compliant, error-free marketing materials
• Use Monday.com to manage creative requests with in-house video, design, copy, and compliance teams
• Leverage Looker and Google Sheets to track channel performance

Digital Marketing Associate

Financial Planning and Analysis

• Direct cost accounting policies, controls, and reporting to drive financial and growth objectives.
• Architect and scale the cost accounting framework, including expense allocation methodologies across all business segments and legal entities.
• Deliver market and product-level profitability analysis to guide leadership on margin optimization.
• Support the financial mechanics of intercompany arrangements, including cost allocation, transfer pricing inputs, and reporting requested by internal and third-party counterparties.
• Build and maintain driver-based financial models that connect membership growth, staffing decisions, and vendor spend to the P&L and cash.
• Support or own aspects of the monthly close related to cost, including accruals, allocations, variance analysis against budget and forecast, and management reporting packages.
• Build business cases and ROI analyses, vendor and build-versus-buy decisions, market expansion and headcount investment, and hold those investments accountable to what was modeled.
• Participate in cross-functional continuous improvement and standardization of policy, process, and control, emphasizing technology development and scalable self-service tooling.
• Support market, network, and clinical teams with education, tools, analysis, and supplemental reporting to manage cost performance.
• Own responsibility for satisfying applicable audit, examination, regulatory, and compliance inquiries and requests.

Senior Financial Analyst, Cost Accounting

• Provide Social Work support to the Palliative Care Program
• Conduct telephonic and video visits with patients and caregivers
• Establish trust and build strong relationships with patients
• Collaborate with clinicians, nurses, care coordinators, and interdisciplinary teammates
• Conduct Social Work interventions and psychosocial assessments
• Create personalized care plans tailored to members’ needs
• Provide emotional and caregiver support
• Assist with complex family and support issues
• Complete goals of care conversations and advanced care planning
• Conduct long-term care planning and placements
• Place and follow through on behavioral health referrals
• Investigate concerns for patient abuse or neglect
• Support patients, caregivers, and families with goals of care and social drivers of advanced care planning
• Facilitate and participate in family meetings and joint visits
• Participate in team huddles, panel reviews, interdisciplinary team rounds, and program development
• Build relationships and coordinate with local market and internal stakeholders
• Document all clinical interactions in the electronic health record

Palliative Care Social Work Case Manager

• Engage with patients telephonically and/or via video to provide home-based palliative care rooted in compassionate, evidence-based clinical practice
• Perform care coordination and case management tasks, including following up on DME orders, collaborating with home health workers, and communicating with PCPs
• Participate in daily team huddles and weekly palliative rounds with the interdisciplinary team
• Maintain a patient panel and conduct routine check-ins based on risk stratification or changes in health status
• Refer patients to the palliative social worker and NP as needed
• Collaborate with other Devoted Medical teams to provide integrated care
• Assist with triaging and responding to incoming calls from palliative patients
• Support palliative education initiatives for Devoted Medical employees
• Work with palliative care teammates to support, care for, and grow the program and its patients

Palliative Care Nurse

Medical Director

• Design the MSK care model and own its clinical architecture end to end
• Define conditions, member entry and triage, first visits, escalation to imaging or surgical consultation, pain management, peri-operative optimization, and post-operative recovery pathways
• Build an agentic AI interface with product and engineering teams
• Encode clinical reasoning, specify system questions, observations, escalations, and prohibited actions
• Shape member engagement between visits, home-program adherence, and deterioration detection
• Carry a shared patient panel and provide care for diagnostic ambiguity, red flags, complex multimorbid presentations, and cases outside pathways
• Hire, train, and lead Advanced Practice Providers, physical therapists, and care team members
• Set encounter standards, hold collaborative practice agreements across multiple states, run case reviews and interdisciplinary rounds, and grow a national team
• Build quality measures, a balanced scorecard, and feedback loops
• Improve clinical pathways and the AI system using function and pain outcomes, imaging and surgical referral appropriateness, opioid stewardship, and member experience

Medical Director, Musculoskeletal MSK Programs

Business Operations

• Own the daily health of the operation by monitoring TAT (Turnaround Time), clearing backlogs, and ensuring queue health remains optimal
• Oversee operational performance and maintain the feedback loop between high productivity and rigorous audit accuracy
• Own the end-to-end design, testing, and launch of scalable cross-functional workflows, including change management, training, and post-launch KPI tracking
• Partner with external vendors and cross-functional stakeholders across Engineering, Network/Provider Operations, Claims, and Integrations
• Align ongoing operational priorities, streamline end-to-end workflows, and drive shared business outcomes
• Identify opportunities to lean out manual processes by deploying and managing AI agents alongside human staff
• Act as the primary escalation point to resolve blockers for vendors and internal teams
• Ensure vendors and internal teams have the training and job aids needed to succeed

Senior Business Operations Manager

Supervisor

• Lead, coach, and develop Guides through tailored plans and constructive feedback
• Conduct 1:1s, observations, and call reviews to ensure quality and drive improvement
• Assess individual strengths and adapt coaching styles to provide actionable feedback
• Foster a psychologically safe, transparent culture that values authenticity
• Act as a player-coach when necessary
• Guide the team through organizational changes with transparency
• Assist in talent acquisition by interviewing and recommending candidates
• Manage team metrics including quality, productivity, compliance, and attendance
• Communicate the rationale behind metrics to motivate Guides
• Address performance gaps promptly with clear paths forward
• Ensure adherence to service levels, quality, and compliance standards
• Handle escalated interactions professionally and use them as coaching opportunities
• Identify process gaps and improve workflows, tools, and member experience
• Champion AI and automation, pilot solutions, and enable team adoption
• Partner with cross-functional teams to enhance resolution
• Support broader Guide organization needs during peak seasons or volume surges
• Provide context and actionable recommendations upward
• Advocate for resources and improvements benefiting the team and members

Member Service Guide, Supervisor

Operations

• Develop Devoted's Models of Care (MOCs) annually in collaboration with the SNP Operations Director
• Oversee and manage Devoted's policies, procedures, and compliance universes in compliance with CMS and Model of Care requirements, ensuring perpetual audit-readiness
• Review new or changing Model of Care and CMS requirements, working cross-functionally to develop and implement operational solutions
• Develop and implement enhanced processes to oversee compliance with Model of Care and CMS-related SNP requirements, including building early warning systems to detect and prevent potential gaps
• Develop Medicaid benefit subject matter expertise, creating knowledge tools and configurations that support frontline staff and members in understanding and coordinating Medicare and Medicaid benefits
• Oversee routine Medicaid reporting with the SNP Operations Director and other SNP Managers, and work cross-functionally to develop and submit required Medicaid reports accurately and timely
• Provide additional compliance and operational support across SNP and Medicaid programs as assigned

Special Needs Plans Operations Manager

• Oversee all aspects of claims benefit setup, analysis, mapping, testing, troubleshooting, and implementation
• Ensure accurate configuration of member cost share, benefit limitations, and provider payment information
• Act as a liaison across departments regarding benefit and claims processing
• Support interpretation, analysis, implementation, and audit of claims configuration, including benefits, authorization, denial library, CMS billing and coding guidelines, and Devoted payment policies
• Manage the claims benefit configuration inbox and respond to stakeholder questions while maintaining turnaround times and response quality
• Develop, implement, and enforce quality control procedures for claims configuration
• Perform routine reviews to enhance configuration accuracy and performance
• Lead end-to-end 1/1 annual readiness for benefit configuration and BID application management
• Establish project timelines, maintain documentation, and facilitate cross-functional alignment with MedProduct, Clinical, and Claims teams
• Oversee the Devoted Denial Reasons library and ensure accurate mapping of internal denial codes
• Identify, design, and implement process improvements to scale configuration operations, reduce error rates, and streamline cross-team execution

Senior Claims Benefit Configuration Associate

Marketing Operations

• Identify opportunities where prospects fall out of direct telephonic/online acquisition funnels
• Propose high-ROI improvements rooted in experience audits and quantitative data
• Partner with Product Management, UX/Design, and Engineering to improve online browsing, comparison, and shopping experiences
• Move new user flows into production
• Drive conceptualization and AI-workflow design for consumer-facing digital experiences
• Build and scale AI agents that analyze prospect and member conversations for moments, quotes, and insights
• Enable experimentation with new channels and offers to broaden the prospect funnel