Risk Adjustment, Operations Manager - Waltham

Job Description · A bit about this role: · We're seeking a highly diligent, process-oriented professional to join our team as an Evaluation Manager. This role is for someone who thrives in fast-moving environments, enjoys building and refining processes, and communicates with cla ...

Job description

Job Description

A bit about this role:

We're seeking a highly diligent, process-oriented professional to join our team as an Evaluation Manager. This role is for someone who thrives in fast-moving environments, enjoys building and refining processes, and communicates with clarity. You'll play a key part in ensuring operational excellence, supporting cross-functional risk adjustment data audit responses, and applying new tools - including large language models - to drive efficiency and quality. This role reports to the Senior Manager, Risk Adjustment External Audit Program.

Your Responsibilities and Impact will include: 

• Manage a multi-step medical document evaluation process with tight turnaround times, ensuring accuracy and consistency in responding to crucial external audit requests

• Oversee and coordinate production work with offshore teams, maintaining clear expectations and quality standards

• Identify opportunities for process improvement and implement changes that enhance scalability, transparency, and quality

• Communicate updates, risks, and recommendations clearly to cross-functional stakeholders 

• Collaborate with risk adjustment coding experts to build a chart evaluation process that extracts the correct information in an efficient and meaningful manner

• Support special projects that require structured thinking, thoroughness, and cross-team collaboration

Required skills and experience: 

• 4+ years experience managing processes with tight turnaround times. You have a high attention to detail and a reputation for following through

• Strong communication skills, both written and verbal. You convey information clearly, proactively, and without ambiguity 

• Ability to pull and analyze data using SQL to form independent insights, identify trends, and validate what's working. Spreadsheets (e.g. Google Sheets) are a favorite tool in your toolkit

• Curiosity and comfort experimenting with AI (including LLMs) or other emerging tools

Desired skills and experience:

• Experience in healthcare operations, operations, or quality assurance

Salary range: $80,000 - $120,000 / year

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.

Our Total Rewards package includes:

• 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....

*Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.

Healthcare equality is at the center of Devoted's mission to treat our members like family.  We are committed to a diverse and vibrant workforce. 

At Devoted Health, we're on a mission to dramatically improve the health and well-being of older Americans by caring for every person like family. That's why we're gathering smart, diverse, and big-hearted people to create a new kind of all-in-one healthcare company — one that combines compassion, health insurance, clinical care, service, and technology - to deliver a complete and integrated healthcare solution that delivers high quality care that everyone would want for someone they love. Founded in 2017, we've grown fast and now serve members across the United States.  And we've just started. So join us on this mission

Devoted is an equal opportunity employer. We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoted's Code of Conduct, our company values and the way we do business.

As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.