Teams at Devoted Health

Performs complex utilization management, appeals, claims, provider dispute, and quality-of-care reviews requiring advanced nursing judgment. Applies InterQual criteria, CMS requirements, Medicare Advantage regulations, medical policies, and benefit guidelines to make and document medical necessity determinations. Analyzes workflow trends, improves policies and processes, supports compliance and audit readiness, and provides clinical expertise, coaching, and escalation support across operational teams.

Manages clinical data acquisition across health plans and medical teams. Analyzes data gaps, develops execution plans, implements integrations with HIEs, labs, EHRs, and aggregators, and ensures data quality and usability. Oversees vendor relationships, interoperability strategies, AI-enabled processes, and KPIs while coordinating internal stakeholders and external partners.

Leads AI performance and quality operations across frontline voice and chat agents. Builds AI-powered interaction monitoring, evaluation, coaching, visualization, and feedback systems that improve member experience and team performance. Partners with frontline leaders to drive adoption, scale successful frameworks, and oversee operators and agent builders. Requires strong data fluency, systems thinking, communication, people leadership, and hands-on familiarity with modern AI tools.