Operations Quality Program Manager
Devoted Health
full-time
Posted on:
Location Type: Remote
Location: Remote • 🇺🇸 United States
Visit company websiteSalary
💰 $80,000 - $120,000 per year
Job Level
Mid-LevelSenior
About the role
- AI & LLM Program Integration: Co-lead design, testing, and implementation of LLM-based tools supporting clinical summarization, level-of-care determinations, and documentation accuracy.
- Track AI performance metrics (accuracy, turnaround time, variance reduction) and escalate potential compliance or bias risks.
- Develop training resources and calibration exercises for clinical staff to effectively use AI/LLM tools in daily operations.
- Quality Oversight & Audit Governance: Identify opportunities for automation within audit workflows and lead initiatives to scale AI- and LLM-assisted reviews.
- Drive operational transparency by developing dashboards, Balanced Scorecards, and executive-level reports that quantify quality, compliance, and efficiency outcomes.
- Monitor and respond to high-risk issues.
- Operational Excellence & Data Analytics: Monitor and analyze operational performance metrics to identify inefficiencies and opportunities for improvement across UM programs.
- Lead cross-functional initiatives to streamline UM workflows, reduce administrative burden, and increase productivity across internal and delegated teams.
- Compliance & Risk Management: Ensure all AI-assisted and manual UM activities comply with CMS Regulations, Regulatory Guidelines, and internal policies.
- Educate and influence teams: Train, guide, and support clinicians and auditors to adopt AI-enabled workflows effectively and responsibly.
Requirements
- Active RN or LPN license with 5+ years of UM experience (inpatient, outpatient, post-acute, or appeals).
- 3+ years of experience in UM quality, audit, or program management.
- In-depth knowledge of UM processes, medical necessity criteria, Regulatory Guidelines, and CMS Regulations.
- Demonstrated ability to implement AI or automation tools within healthcare operations.
- Strong analytical, communication, and project management skills.
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....
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
AI integrationLLM toolsclinical summarizationperformance metricsdata analyticsautomationquality oversightaudit governancedashboard developmentprogram management
Soft skills
analytical skillscommunication skillsproject managementtrainingguidanceinfluencecross-functional leadershipoperational transparencyproblem-solvingteam collaboration
Certifications
RN licenseLPN license