Inpatient Quality Program Manager

Inpatient Program Manager

A bit about this role : The Inpatient Program Manager is a high-impact, hands-on leader responsible for driving clinical quality, regulatory compliance, and operational efficiency across the Utilization Management (UM) department. This role combines advanced UM expertise, AI / LLM integration, and data-driven decision-making to transform clinical review, audit, and workflow operations. The Program Manager will oversee all Quality activities within the Inpatient Team, lead AI-powered audit initiatives, and ensure all IP processes meet Regulatory and CMS Regulations. This is a fast-paced, high-change environment requiring someone who thrives on operational challenges, can manage multiple priorities simultaneously, and is comfortable leading innovation at the intersection of clinical operations and technology.

Your responsibilities and impact will include :

• Lead New Hire Onboarding & Development Build and maintain standardized training, assess learning milestones, and provide targeted re-education to support progression into more complex clinical reviews.
• Monitor & Improve OD Compliance Partner with Compliance, A&G, and UM leadership to track OD timeliness, accuracy, and overturns; use insights to mitigate risk and drive continuous improvement.
• Integrate CMS Regulatory Updates Stay current on OD-related CMS changes and embed updates into SOPs, training materials, and clinical review practices; proactively re-educate staff.
• Drive Clinical Decision Quality Evaluate clinical decision-making for accuracy, consistency, and adherence to evidence-based criteria; use audits to identify trends and direct interventions.
• Lead Remediation & Quality Improvement Develop and deliver corrective action plans, workflow refinements, and policy updates based on error patterns or emerging risks.
• Provide SME Guidance & Real-Time Coaching Serve as a clinical and operational resource; support staff with real-time problem solving and reinforce best practices.
• Deliver Ongoing Education & IRR Conduct in-services, case studies, and cross-functional learning sessions; manage IRR reviews and implement training based on results; maintain a comprehensive learning library.
• Maintain Clinical Tools & SOP Alignment Curate job aids, decision tools, and supplemental materials; support annual SOP reviews to ensure accuracy, consistency, and compliance.
• Support Team Operations & Cross-Functional Work Participate in weekly assignment planning, team meetings, committees, workflow changes, and partner-department initiatives; respond to interdepartmental questions.
• Advance AI / LLM Adoption in Clinical Practice Utilize AI / LLM models to strengthen decision quality and predictive analytics; implement AI-driven tools; train staff on effective use of AI in clinical workflows.

Required skills and experience :

Desired skills and experience :

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 :

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.