Job description

The vision of Colorado Access is to have healthy communities transformed by the care that people want at a cost we can all afford. Our mission is to partner with communities and empower people through access to quality, affordable care.

Why should you consider a career with Colorado Access?

We are a Colorado-based company, working to improve the health of our state. We care for individuals, families, and children who receive health care under Child Health Plan Plus (CHP+) and Health First Colorado (Colorado's Medicaid Program). Our focus is driving improvements in quality, member experience, outcomes, and cost. We are a mission-driven organization whose foundation is built by our vision, supported by our values and pillared by diversity, equity and inclusion.

1. Find work/life balance: We offer PTO, floating holidays, seven company paid holidays, work from home options (exceptions apply), an Employee Assistance Program and a 401K.
2. Be a part of something bigger and make an impact: We serve the underserved and most vulnerable populations in our community through access to quality and affordable health care. No matter what you do for Colorado Access, you are impacting our community and making a difference.
3. Sharpen your skills, learn, and grow: We support your continued development through tuition reimbursement, leadership training, promotion opportunities, performance evaluations, employee recognition, and a language pay stipend.

What you will do:
We are looking for an Director of Utilization Management like you who can help shape our vision and support our mission. Here is what the day-to-day functions will look like:

Department Director Responsibilities:

• Provides strategic direction and oversees the management and maintenance of department deliverables striving for operational excellence (productivity, quality, SLAs, customer experience of services provided, etc.). Builds high performing teams with vision, leadership, goals and metrics. Serves as a role model for team members; takes action and inspires team members to embrace and implement culture initiatives. Provides awareness to staff how their work impacts other departments, programs and the enterprise. Encourages collaboration and holds team members accountable for achieving outstanding results.
• Responsible for all management functions including: hiring, training, planning and directing work, coaching and staff development, managing and evaluating performance, recognizing and rewarding employees; corrective action procedures and practices, addressing complaints and resolving problems. Develops and manages the department budget.
• Works closely with Directors across the organization to make tactical and operational decisions that advance company strategies and goals and collaborates to deliver on company-wide deliverables/requirements.
• Oversees/leads departmental projects and continuous improvement initiatives; may lead cross functional teams.
• Develops and implements department policies and procedures to ensure compliance with federal, state, local and company policies, rules and regulations.

Job Specific Responsibilities:

• Directs and develops the UM program annually and ensures the success of UM functions through medical review and prior authorization, behavioral health management, clinical intake, and inpatient and outpatient review.
• Directs and develops specialty programs to support and ensure success of the UM program, inclusive of innovative programs that emphasize and utilize hospital collaborative work relationships, and internal and external partnerships; ensures compliance and administration of utilization policies through cost effective management of UM operations.
• Conducts clinical and financial oversight of pharmacy team, pharmacy benefits, and pharmacy benefit manager (PBM).
• Develops, secures approval and monitors and reports on area operating budget; forecasts spending levels, staffing requirements and resource needs for area.
• Provides overall direction, design, development implementation and monitoring of utilization programs to meet utilization goals while maintaining customer satisfaction.
• Acts as a resource to the clinical staff, administrative staff, and external regulatory agencies in all issues relating to utilization management.
• Analyzes and reports significant utilization trends, patterns, and impact to appropriate departmental and medical staff committees.
• Develops, monitors and controls department's budgets.
• Assures compliance with Federal, State, other regulatory agencies and internal standards and requirements. Ensure services are in compliance with professional standards, state and federal regulatory requirements.
• Hires, coaches, trains and disciplines staff to ensure smooth operations in utilization management.
• Also facilitates educational training for clinical staff on issues related to utilization management.

What you will bring:
Education: Master’s degree in behavioral health field, nursing, health services administration, or other related health care field; or an equivalent combination of education and experience.

Experience: Ten years of healthcare experience required, with five years in a managed care environment with progressive management experience. Must have experience in effectively managing a diverse group of professionals with varying backgrounds. Experience with program development and implementation required. Experience working with the Medicaid population and in a managed care setting preferred. Must have some public speaking experience.

Knowledge, Skills, and Abilities: Demonstrated interpersonal, negotiation, and leadership skills. Effective oral and written communication skills Ability to work independently and set priorities and meet challenging goals. Excellent time management skills with the ability to multi-task required. Knowledge of managed care, case management, utilization management, and systems which are integrated with Medical Management. Must be able to direct staff in a manner that promotes team building and communication. Must have excellent written and verbal communication and presentation skills. Must have working knowledge of word processing and spreadsheet programs, preferably in Microsoft Office. Knowledge of care coordination/utilization management software preferred. Knowledge of ICD-10, CPT4, HCPC coding required.

Licenses/Certifications: Clinical Licensure in field of study is required (e.g., RN, LPN, LPC, LCSW, LMFT, LAC). A valid driver's license and proof of current auto insurance will be required.

Together we will be: an innovative and collaborative team who supports each other, the employees and vision of the company to reach our goals individually, together and as an organization.

Pay, Perks and Benefits at Colorado Access:
The compensation for this position is $120,000.00 to $136,000.00 annually. The salary is commensurate with experience.

In addition to being part of a mission driven organization serving our community, as an eligible Colorado Access employee, you’ll receive a generous benefits package, that includes:

• Medical, dental, vision insurance that starts the first day of the month following start date.
• Supplemental insurance such as critical illness and accidental injury.
• Health care and dependent care flexible spending account options.
• Employer-paid basic life insurance and AD&D (employee, spouse and dependent).
• Short-term and long-term disability coverage.
• Voluntary life insurance (employee, spouse, dependent).
• Paid time off
• Retirement plan
• Tuition reimbursement (based on eligibility).
• Annual bonus program (based on eligibility, requirements and performance).

Where you will work:
This position will be a hybrid model work environment, a blend of ‘In-Office’ and ‘Remote.’

We are not able to support out of state employees at this time as we continue to serve our members and community in the metro Denver area and across the beautiful state of Colorado.

COVID-19 Vaccination Notice:
In compliance with state and federal guidance, Colorado Access has adopted a policy addressing vaccination and testing requirements to protect the health of employees and their families, our members, vendors and visitors of Colorado Access. All new hires must present proof of COVID-19 vaccinations or agree to testing protocols at the time of hire.

Colorado Access is committed to providing equal opportunities to all people regardless of race, color, national origin, age, sex, genetic information, religion, pregnancy, disability, sexual orientation, veteran status or any other status protected by applicable law. We strive to maintain a work environment that is free from unlawful harassment and discrimination.

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