Director, Member Status - Strategy & Operations

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 Determinations Own the end-to-end operation for each area: from identifying a potential issue, to investigating it, making the right determination, submitting any required updates, checking the work for accuracy, and making sure any follow-up action gets completed. Manage these areas with clear daily and weekly checks so we catch important status changes as they happen, rather than finding them after the fact. Take direct ownership of the workflows that are not yet mature, and prioritize improvements based on member impact, financial risk, and compliance risk - not just what is easiest to fix. Keep the operation current with CMS technical guidance, including Medicare Secondary Payer rules, hospice and ESRD payment treatment, and county-based rate structures. Maintain the policies that define what makes a suspect, what evidence substantiates a determination, and how it is documented, so any determination can be reproduced on demand for a CMS program audit, state review, or internal audit. Report accuracy misses that reduce revenue with the same rigor as those that increase it. Use AI and other tools to make these workflows more efficient, including identifying potential issues earlier and reducing manual review where it makes sense. Set, monitor, and enforce SLAs and KPIs across internal teams, offshore partners, and external vendors. Reconciliation and Controls Define and deliver the KPIs that measure the operation — detection coverage, open inventory aging, signal-to-determination cycle time, rework, retroactive adjustment rates — and make them visible in executive-facing dashboards alongside recovered and at-risk revenue and outstanding variances. Run expected-vs-actual analysis to flag macro-level payment degradation early and direct remediation to the conditions driving it. Convert manual detection and correction into documented, owned controls with defined thresholds, aging limits, and escalation paths, so the operation does not depend on individual heroics or tribal knowledge.