Devoted Health

Role Description The Clinical Guide Part A will be part of the Utilization Management team, responsible for inpatient, behavioral health, and/or post-acute authorization review in alignment with CMS and Medicare Advantage regulations. - Reviews medical records to evaluate the medical necessity and appropriateness of requested inpatient and/or post-acute services in accordance with established clinical criteria and CMS guidelines. Your Responsibilities and Impact will include: - Review Medical Records: Conduct prospective (pre-service), concurrent, and retrospective utilization review to evaluate medical necessity, appropriate level of care (Inpatient vs. Observation), and post-acute services in accordance with established clinical criteria and CMS guidelines. - Evaluate Treatment Plans: Assess the appropriateness, timing, and setting of requested services, ensuring alignment with medical necessity criteria and Medicare Advantage requirements. Recommend alternative levels of care when clinically appropriate. - Inpatient & Behavioral Health Review: Perform initial, concurrent, and discharge reviews for inpatient and behavioral health admissions. Ensure admission status accuracy and regulatory compliance with CMS timeliness (TAT) standards. - Post-Acute Review: Conduct initial authorization and concurrent review for post-acute services (SNF, LTACH, ARU, Home Health), evaluating ongoing medical necessity and appropriate length of stay. Issue NOMNC when coverage criteria are no longer met. - Medical Director Collaboration: Refer cases that do not meet criteria to the Medical Director for secondary review and final determination. Prepare clinical summaries and coordinate peer-to-peer (P2P) discussions. Manage authorization reopen requests as appropriate. - Resource Stewardship: Monitor utilization of inpatient and post-acute services to promote appropriate resource use while maintaining high-quality, member-centered care. - Regulatory & Documentation Compliance: Maintain accurate, defensible documentation of all determinations. Ensure adherence to CMS regulations, Medicare Advantage requirements, and internal compliance standards. Qualifications - Unrestricted RN license with a minimum of 4 years of clinical experience. - Minimum 3 years of Utilization Management or Inpatient UR experience within a health plan or hospital setting. - Strong knowledge of CMS regulations and Medicare Advantage requirements. - Experience preparing cases for Medical Director review. - Able to work in a fast paced environment that is constantly evolving. Requirements - Experience with AI/LLM. - Certified in InterQual. 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....

Role Description A bit about this role: As a Social Work Case Manager, you will support the care team in serving our patients and assist with care plans that promote patient well-being by coordinating services to address socioeconomic and psychosocial needs. This will involve supporting the development of care plans that align with community, clinical, and financial resources while providing coaching and support to patients and their caregivers. Additionally, you will support the improvement of coping skills, self-management, and caregiver assistance; and facilitate advanced care planning discussions, including palliative or hospice care transitions when appropriate. You will examine, challenge, and seek to expand how the community environment supports the patient’s needs, and work closely with other members of the multidisciplinary team. Responsibilities will include: - Establish trust and build strong relationships with our patients telephonically and virtually. - Interdisciplinary collaboration with the interdisciplinary team (including clinicians, case managers, community health workers, and coordinators) to ensure cohesive, patient-centered care for high-needs patients. - Engage with patients to identify social barriers to assist in resource alignment, & coordination services to maximize the effectiveness of the Complex Care Department. - Conduct screenings and create personalized action plans tailored to patient’s needs. - Recognize caregivers who exhibit signs of burnout or are actively coordinating the patient's care, providing emotional support and additional resources when needed. - Assist in navigating complex family/support issues. - Facilitate conversations about end-of-life planning. - Collaborate with patients to identify their long-term care planning needs and goals. Provide information on available options and support in arranging referrals and coordinating necessary care. - Coordinate care between the Devoted Medical Behavioral Health Team and monitor outcomes. - Know how to balance multiple competing priorities for complex patients. - Build relationships and coordinate with key local market and internal stakeholders. Qualifications - Ability to work in a fast-paced environment. - Embrace, crave and be comfortable with new and ever-changing technologies. - Have a minimum of 3 years working in medical social work, case management, or care coordination. - Master’s degree in social work and active state license. - Bilingual in Spanish preferred. - Health insurance experience preferred (Medicare Advantage a plus). - Experience working with the senior population a plus. - You’ve had proven success in building relationships with patients and an interdisciplinary team. - The ability to comfortably multi-task: you’ll be listening, talking, evaluating and writing notes all at the same time. - You’re a great team member with a can-do attitude; you’re self-reflective. - Comfortable with working remotely. Requirements - You’re a caring problem solver who can break down barriers. - You connect with people quickly. - You can prioritize needs against multiple competing demands. - You follow up relentlessly. - You have comfort in the weeds of logistics. - A deep caring to make a change in the healthcare experience: you love to serve and make a difference. - The ability to adjust your tone and approach to different people. - You can articulate and break down complex information for an interdisciplinary team to be able to coalesce around a plan of care. - Are present, reliable and timely for our patients and the team. - The ability to work in a changing environment: which means moving quickly and being transparent in your work, what’s going well, what’s not. 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.... Salary Salary range: $70,000 - $85,000 annually. The pay range listed for this position is the range the organization reasonably and in good faith expects to pay for this position at the time of the posting. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered will depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.

• Deliver exceptional care to a cohort of complex patients across multiple geographies, leveraging video telehealth visits and an interdisciplinary team. • Guide and oversee the medical management of patients (utilizing the 5M framework) during their tenure with Gold Care. • Work closely with other members of the patient's care team including their PCP, specialists, and other Devoted teams such as pharmacy, or specialty care. • Collaborate with the patients’ support systems such as family members and caregivers in order to coordinate care for the patient and deliver a collaborative care plan. • Perform comprehensive assessment visits, provide post-acute transition support, comprehensive diagnosis/disease review, medication review, and assessment for quality of care (Stars/Hedis) interventions as well as social and home health/DME needs. • Maintain accurate and up-to-date patient medical records, ensuring compliance with relevant legal and ethical guidelines. • Adhere to all relevant laws, regulations, and industry standards, including patient privacy and telehealth regulations.

• Evaluate and execute debt and equity capital raising transactions; Full spectrum of process ranging from evaluation/analysis of capital alternatives through selection, negotiation, marketing, and execution of transactions • Manage engagement with current and potential capital partners (both investor and investment bank relationships) including deepening relationship development, fulfilling reporting requirements, sharing business updates, and responding to diligence requests; Implement new and improved tracking of investor interactions • Work cross-functionally with partners across the finance department and broader organization to build financial models to drive key business decisions • Develop update materials, reporting and analyses for Management and Board, particularly for the quarterly Board meeting cycle

• Calling (inbound/outbound) patients to check in after discharge to see how they are doing, and that they have received the assistance they need. • Work with affiliated vendors to coordinate services and care for members, to include transportation, DME, meals, home health care and more as appropriate. • Assisting with scheduling of post discharge TOC APP, PCP, and Specialist visits. • Collaborate with patients, providers, and caregivers to ensure a positive outcome. • Working hand in hand with the other members of the TOC team to address patient needs towards team based goals. • This may include interdisciplinary huddles. • Participating in and assisting with pilot programs. • Coordinating with medical providers and facilities to access necessary discharge records. • Following escalation processes to the clinical team to ensure patients get needed evaluation and care.

• Conducting outreach via telephone and SMS to educate and inform members of available clinical programs or important screenings relevant to them • Ensure patients remain connected to care throughout their time in the program • Schedule initial appointments, thoughtfully adjusting calendars to meet urgent care needs • Provide inbound call support/call routing for patients with clinical or administrative questions • Communicate frequently with care team members and leadership • Develop a solid understanding of our benefit offerings to investigate and resolve member questions • Document accurate information about member needs in our system • Support the team with daily tasks, including administrative work • Pilot new processes and workflows • Work hand-in-hand with other Devoted teams to address member needs

• Must be located somewhere between the Philadelphia and Harrisburg areas • As the Broker Manager you will be responsible for the success, engagement and production of our independent agents. • You will work closely with Operations and field sales management to ensure the brokers have clear line of sight to Devoted's mission and the plan for growth. • Executing the plan created by the team for the market's brokers • Analyzes reports and providing a plan of action for increased production • Providing real time feedback from the field brokers. • Training for brokers both classroom and field • Influence brokers to sell more by positioning our product and promoting our brand • Responsible for a territory, manage contacts • Execute on market / region sales goals and objectives (sales events, training, etc) • Meet or exceed sales objectives through broker channel • Meet with brokers and agencies to build relationships and promote our brand • Responsible for reporting their daily activities to ensure alignment with creating incremental sales consistent with market goals • Adheres to and maintains current understanding of compliance requirements and organizational policies & procedures • Coordinates effectively with local sales team

• Working under the direction of Devoted Health’s legal team, assist and lead on a variety of legal and business tasks important to the Company’s growth across markets, products, and service offerings. • Primarily focused on supporting Devoted Health’s corporate governance operations including: entity formation filings, subsidiary maintenance, support for Boards of Directors, committees, and meticulous maintenance of corporate records and documentation to support regulatory compliance. • Draft and maintain corporate governance documentation, including entity formation filings, subsidiary maintenance and corporate records. • Draft and file required documents with government entities, including Departments of Insurance and Secretaries of State, on behalf of Devoted and its subsidiaries, and maintain corporate records for those entities. • Support and engage in regular direct communication with various regulators and agencies in response to inquiries, requests for information, and submission of documents. • Work often managed and guided by precedent and/or documented procedures/regulations/professional standards with some interpretation. • Collaborate with key Devoted business segments, such as business compliance, to support the Company’s strategic initiatives and to provide general corporate guidance. • Work with in-house attorneys, other paralegals, and outside counsel when necessary.

Role Description This role is fully remote and must be located within the 50 U.S. states. Standard working hours are in Eastern Timezone. Semi-annual travel may be required to a Devoted office for on-site work. At Devoted, our mission is to dramatically improve the health and well-being of our members by treating each of them like family. Core to this mission is ensuring our members receive the right care, at the right time, in the right setting. This is our work, and we are passionate about it because it matters deeply to our members and provider partners. We are seeking a leader to serve as the Director of Utilization Management Operations. This individual will be a cornerstone of our Health Services division, bridging the gap between complex clinical needs and scalable, efficient business processes. You will lead a team of clinicians and coordinators, alongside a critical offshore vendor partnership, to ensure our utilization management processes deliver timely and accurate decisions. - Mission-Driven Clinical Leadership: Provide leadership and professional development to clinical and non-clinical teams. Foster a culture of integrity and clinical excellence, ensuring all UM activities align with Devoted’s goal of treating members like family. - People & Vendor Management: Directly lead a team of Senior Managers and Managers who oversee teams of nurses and intake coordinators. Manage our offshore partnership, ensuring their performance metrics and workflows are aligned with department targets. - Technology & AI Stewardship: Evaluate and prioritize improvement opportunities to ensure our technology supports accurate and efficient workflows. Engage with our AI tools for process and platform improvement while ensuring strict compliance with our AI Governance and Oversight policies. - Data-Driven Operations: Partner closely with Data Science and Engineering teams to identify key measurement points. Develop, implement, and systematically monitor comprehensive KPIs to ensure operational health and decision accuracy. - Regulatory & Compliance Excellence: Partner with Compliance and Legal teams to ensure the operation is consistently audit-ready. Digest complex regulatory guidance and translate it into compliant, high-quality operational workflows. - Strategic Stakeholder Collaboration: Act as a close partner to the Provider Network team to ensure our operation is responsive to feedback from provider and facility partners. Partner with Pharmacy UM and the UM Medical Director team to facilitate appropriate service use and minimize care barriers. Qualifications - Demonstrated experience leading large clinical teams. - Understanding of the nuance required when managing clinicians and healthcare workflows. - Track record of transforming complex operational challenges into scalable business processes in a fast-paced environment. - Data-driven mindset with the ability to use insights to drive decisions. - Genuine interest or experience in leveraging AI-enabled tools to optimize clinical workflows. - High ethical standards with the ability to master complex regulatory guidance and incorporate it into daily operations. - Exceptional written and verbal communication skills, with the ability to distill complex problems into actionable updates for leadership. Requirements - Prior experience in Utilization Management processes and the medical necessity review lifecycle is highly beneficial but not strictly required if clinical leadership experience is strong. - Familiarity with Medicare Advantage operations and CMS guidelines. - MBA or advanced degree in health administration or finance is a plus. 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...

• Build and deploy digital marketing campaigns across multiple channels such as Meta, YouTube, Search, and more • Coordinate with external ad vendors • Collaborate with our creative team to produce beautiful 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 our in house video, design, copy, and compliance teams • Leverage Looker and google sheets to track channel performance