Director, Member Status - Strategy & Operations

Job Description

*A bit about this role:*

At Devoted, our mission is to dramatically improve the health and well-being of our members by treating each of them like family. Getting a member’s record right is part of that promise. When we carry the wrong primary payer, miss a hospice election, or have a stale address on file, the member feels it before it shows up in a report. Doing this work well is an important part of making sure members can rely on us for the care they need

We are seeking a leader to serve as the Director of Membership Status Operations. This role owns the member status conditions that determine what CMS and our state partners pay us once enrollment is complete,along with the reconciliation and controls that make those determinations reliable. The role pairs regulatory expertise with financial and operational discipline, managing these conditions as a dynamic portfolio in which an undetected or late determination can create downstream disruption for the member and keep us from delivering the seamless experience we expect.

Membership Operations has built real capability in reconciliation: confirming that every member we are responsible for is enrolled correctly and at the right effective date and rate given the information available at point of application. You will own the next stage of that work. Several of these areas are still immature, and your first job is to be honest about which ones and to build the durable, monitored, auditable operation they require. The objective is accuracy in both directions — payment that reflects the member’s true status, whether that means we are owed more or owe money back. You will directly engage with AI-enabled tools to optimize signal detection, document review, and investigation triage.

This is foundational work - and there is a meaningful opportunity for this leader to leave their fingerprints all over how we do it.

*Your Responsibilities and Impact will include:*

**Member Status