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Department

* Must Live in Colorado

* This is a hybrid role located in Denver, Colorado with a requirement of being in the office 3 days per week.

Job Summary

The Director of Health Plan Care Management is a senior leader for the Denver Health Medical Plan (DHMP). The scope of responsibility for this role includes the overall leadership, management and oversight for all Care Management (CM) functions. These functions include but are not limited to: Complex Case Management (CCM), Transitions of Care (TOC), D-SNP Model of care, Care Coordination (CC), Disease Management (DM) and other population health risk stratification efforts. These areas have unique regulatory and contractual compliance requirements for each line of business. The Director oversees and leads multiple teams performing and collaborating with stakeholders to accomplish this work. The Director reports to the DHMP Medical Director and collaborates closely with them to develop and update the Care Management vision and strategy. This position has direct responsibility for ensuring that CM functions are performed in accordance with all contractual and regulatory requirements. The Director is responsible for coordinating with the DHMP Compliance Officer to meet the expectations of all federal and state agencies. This position will also prepare and assist with all regulatory reviews including but not limited to federal, state (Health Care Policy and Financing) and Colorado Division of Insurance.
The Director is responsible for strategic programmatic development, management of staffing, implementation and monitoring to meet all CM related Service Level Agreements (SLAs) for all DHMP lines of business. They will collaborate with the finance department to develop a budget. They will plan and execute the departmental strategy within the budgetary constraints.
The Director serves as a primary liaison between the CM team and internal or external stakeholders, including our network of providers, members and other community stakeholders. They collaborate across the organizations departments, (including Ambulatory Care Services (ACS) and Inpatient settings) to ensure members receive appropriate coordination of services.
The Director is responsible for oversight and management of any subcontracted CM activities and will maintain and manage strategic vendor relationships.
The Directors role requires collaboration and problem solving across multiple departments. They are responsible for collaboration with data teams to develop, implement and validate reports used to make operational decisions and to effectively utilize metrics/ data to determine department and program effectiveness.


Essential Functions:

• Lead the development of the departmental vision and strategy. (5%)
• Direct and oversee the strategy for implementation (5%)
• Responsible for the continuous development, improvement, maintenance, and monitoring of DHMP’s CM department policies and procedures and workflows consistent with external regulatory NCQA, Medicaid, CMS accreditation and Division of Insurance requirements. (5%)
• Collaborates with internal and external stakeholders to develop and implement CM programs and processes that ensure members’ care is coordinated and managed appropriately. (5%)
• Collaborate with the behavioral and medical providers and subcontractors; to ensure coordination of care across the spectrum of services for DHMP members. (5%)
• Responsible for oversight of CM programs and processes and ensures that all contractual and regulatory requirements for all lines of business are met. (5%)
• Reviews new contractual and regulatory requirements and develops strategies to meet them. (5%)
• In consultation with the Medical Director, Directs and is responsible for the organization of the employees in the CM department and works with Direct reports to manage the clinical and operational challenges of all the CM teams. (5%)
• Oversees departmental policies and procedures and sets departmental expectations for productivity, culture and effectiveness. (5%)
• Prepares required reports to senior management as needed or as anticipated may be helpful in strategic planning and decision making. (5%)
• Oversee and manage the staffing /hiring process in order to maintain an effective and efficient operations. (5%)
• Assures that processes are in place to appropriately train all staff about policies and procedures and software applications necessary to perform their job functions. (5%)
• Participates in presentation of reports to the Operations Team, DHMP Board of Directors, and other bodies, as required. (5%)
• Participates and contributes meaningfully in Quality Management Committee, DHMP Operations Team meetings, enterprise Care Coordination meetings and other related meetings and activities as required. (5%)
• Serves as an issue-related or escalation liaison between the CM functions and other departments and agencies both within DH as well as those with contractors and in the community. (5%)
• Oversees vendor contracts and develops, analyzes, and presents reports on delegated vendor productivity, quality and outcomes. (5%)
• Ensures DHMP can provide documentation of compliance with contractual and regulatory requirements prior to audit by the State, CMS, DOI, etc. (5%)
• Supports internal or external Corrective Action Plans (CAPs) by identifying areas for improvement, developing CAP’s and overseeing the actions required to complete it. (5%)
• Shares knowledge with staff on an ongoing basis both informally and formally. (5%)
• Develops, implements, and evaluates formal educational activities and follows up on issues identified through educational activities. Brings new knowledge to staff meetings. (5%)
• Works closely with DHMP Compliance Officer to ensure all DHMP lines of business operational performance meets or exceeds regulatory requirements including, but not limited to, policies and procedures reporting. Acts as a voting member of the DHMP Compliance Committee. (0%)
• Interfaces with data teams to extract, analyze and optimize data sources to measure department performance and evaluate program effectiveness, including data from disparate sources. (0%)
• Utilize analytics to risk stratify populations and subsets of populations in compliance with requirements of each line of business as well as develops targeted and effective interventions that support the overall goals of DHMP in caring for its members. (0%)
• Collaborates and problem solve by organizing cross departmental teams to achieve an objective. (0%)

Education:

• Bachelor's Degree required

Work Experience:

• Seven years of experience in administration in a managed care, health plan or healthcare provider organization required

- And -

• Three years of supervisory and management experience required

Licenses:

Knowledge, Skills and Abilities:

• Knowledge of regulatory and accreditation standards for health plan and/or healthcare systems preferred.
• Strong health plan or healthcare system administrative leadership skills preferred.
• Strong program development, analysis, and evaluation skills preferred.
• Demonstrated excellence in managing people and processes.
• Strong leadership skills with ability to engage multidisciplinary clinical and non-clinical teams to solve complex problems.
• Strong collaborative skills and ability to interface with clinical and non- clinical health care providers.
• Strong knowledge and experience in case management principles, concepts, and strategies preferred.
• Ability to develop and maintain effective relationships with internal and external stakeholders.
• Proficient in Microsoft Office Suite.
• Proficient in use of Microsoft Excel to perform data analysis using statistical formulas, pivot charts and data visualization.
• Proficient in any health plan or healthcare documentation software.

* Must Live in Colorado

* This is a hybrid role located in Denver, Colorado with a requirement of being in the office 3 days per week.

Shift

Work Type

Salary

Benefits

At Denver Health, we take care of the people who take care of our community. Our benefits are built to support your life, your family, and your future — with generous paid time off, fully paid parental leave, exceptional retirement contributions, comprehensive health coverage, and nationally recognized well-being programs. We invest in your growth through tuition assistance, career advancement pathways, and professional development — while also offering meaningful financial advantages through loan forgiveness eligibility and employer contributions. When you join Denver Health, you’re joining a mission-driven organization that invests in you.

Here is a small list of our benefit programs:

• Paid time off starting at 28 days per year, inclusive of vacation, personal/sick, and 7 Holidays
• 100% paid parental leave up to 6 weeks
• Immediate eligibility for retirement plans with employer contribution up to 9.5%
• Generous medical, dental, vision plans in addition to employer paid disability and life insurance.
• Comprehensive well-being programs including on-site employee fitness center located on Denver Health main campus and nationally recognized RESTORE Center
• Free RTD EcoPass (public transportation)
• Childcare discount programs & exclusive perks on large brands, travel, and more
• Tuition reimbursement & assistance
• Education, coaching, and professional development opportunities through the Workforce Development Center (WFDC) that support internal career growth and advancement pathways
• Professional clinical advancement program & shared governance
• Public Service Loan Forgiveness (PSLF) eligible employer+ free student loan coaching and assistance navigating the PSLF program
• National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer

About Denver Health

Denver Health is an integrated, high-quality academic healthcare system considered a model for the nation that includes a Level I Trauma Center, a 555-bed acute care medical center, Denver’s 911 emergency medical response system, 10 family health centers, 19 school-based health centers, Rocky Mountain Poison & Drug Safety, the Public Health Institute at Denver Health, Denver Health Medical Plan and Denver Health Foundation.

As Colorado’s primary, and essential, safety-net healthcare system, Denver Health is a mission-driven organization that has provided millions in uncompensated care for the uninsured each year.

Located near downtown Denver, Denver Health is just minutes away from many of the cultural and recreational activities Denver has to offer.

Denver Health is an equal opportunity employer (EOE). We value the unique ideas, talents and contributions reflective of the needs of our community. All job applicants for safety-sensitive positions must pass a pre-employment drug test, once a conditional offer of employment has been made. Applicants will be considered until the position is filled.