Senior Director, Health Plan Utilization Management - Denver Health Medical Plan (Must Live in Colorado. Weekly On-Site Requirement))

Denver Health • $143K — $237K *

Denver, CO 80219In-Person

Healthcare

5 - 7 years of experience

Reposted 1 week ago

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Job Overview by Ladders

Qualifications

Master's degree required
Graduation from an accredited educational program for Nursing or Physician's Assistants required
Seven years of experience in managed care administration or healthcare provider organizations required
Five years of supervisory and management experience required
1-3 years of Health Plan or healthcare experience including Medicare, Medicaid, and Commercial Plans required
1-3 years of experience in managing vendors required

Responsibilities

Ensure staff are trained on necessary software programs
Present reports to the Operations Team and DHMP Board of Directors
Participate in quality management and operational meetings
Serve as a liaison between Utilization Management and other departments
Oversee development and implementation of utilization management policies
Analyze and present reports on productivity and quality outcomes
Ensure compliance documentation is ready for audits

Benefits

Paid time off starting at 28 days per year
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 with employer paid disability and life insurance
Comprehensive well-being programs including on-site fitness center
Free public transportation EcoPass
Childcare discount programs and exclusive perks
Tuition reimbursement and assistance
Opportunities for professional development and career advancement
Public Service Loan Forgiveness (PSLF) and other loan assistance programs

Full Job Description

We are recruiting for a mission-driven Senior Director, Health Plan Utilization Management - Denver Health Medical Plan (Must Live in Colorado. Weekly On-Site Requirement)) to join our team!

Department
Managed Care Administration

* 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 Senior Director of Health Plan Utilization Management is a senior leader for the Denver Health Medical Plan (DHMP) with responsibility for providing strategic and operational leadership for all utilization management functions across the organization. This area has unique regulatory and contractual compliance requirements for each line of business. This role is responsible for ensuring clinically appropriate, cost-effective, and regulatory-compliant medical necessity determinations while supporting high-quality member outcomes and provider collaboration. The Senior Director partners closely with Operations, Network Management, Quality, Compliance, and Finance to align utilization management strategy with organizational goals. In this capacity, the Senior Director oversees multiple teams performing this work. The Director reports to the DHMP Chief Medical Officer and collaborates closely with them to develop, update and implement the DHMP Utilization Management vision and strategy.

Essential Functions:

Assures that all staff are appropriately trained on all relevant software programs and applications necessary to perform their job functions. (10%)
Participates in presentation of reports to the Operations Team, DHMP Board of Directors, and other bodies, as required. (10%)
Attends and participates in Quality Management Committee, DHMP Operations Team meetings, Utilization Management Committee, enterprise Care Coordination meetings and other related meetings and activities as required. (10%)
Serves as an issue-related or escalation liaison between Utilization Management and other departments and/or agencies both within DH, contractors and/or plan members. (10%)
Oversees the maintenance, development, implementation, and continuous improvement of UM policies and procedures and management of information systems to accomplish UM goals for all contracted populations. (10%)
Develops, analyzes, and presents reports on productivity, quality and outcomes. (10%)
Ensures DHMP can provide documentation of compliance with contractual and regulatory requirements prior to audit by the State, CMS, DOI, etc. (10%)
Develops, implements, and evaluates formal educational activities and follows up on issues identified through educational activities. Brings new knowledge to staff meetings. (10%)
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. (10%)
Ensures routine and ad hoc reporting available which may include utilization data by setting (inpatient, outpatient, and Pharmacy), or other special projects supporting the overall goals of DHMP. (10%)

Education:

Master's degree required
Graduation from an accredited educational program for Nursing or Physician's Assistants required

Work Experience:

Seven years of experience in administration in managed care, health plan administration or healthcare provider organizations requiredAND
Minimum of five years of supervisory and management experience requiredAND
1-3 years Health Plan or healthcare experience with various lines of business including Medicare, Medicaid, CHP, Exchange and/or Commercial Plans requiredAND
1-3 years Experience in managing vendors required required

Licenses:
Knowledge, Skills and Abilities:

Knowledge of regulatory and accreditation standards for health plan or healthcare operations required.
Strong program development, analysis, and evaluation skills required.
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 knowledge and experience in utilization principles, concepts, and strategies preferred.
Ability to develop and maintain effective relationships with internal and external stakeholders.

* 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
Days (United States of America)

Work Type
Regular

Salary
$143,800.00 - $237,300.00 / yr

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 stands as a beacon of healthcare excellence in Denver, Colorado. Denver’s comprehensive healthcare system offers an array of high-paying jobs and rewarding career opportunities. This integrated network, encompassing a premier hospital, a series of community health centers, and a robust public health department, serves as the city's primary safety net institution. As a Level One Trauma Center with specialized pediatric and neonatal intensive care units, Denver Health is not only pivotal in providing critical care but also plays a significant role in medical education, being affiliated with the University of Colorado School of Medicine.

Overview of Denver Health Careers

A Diverse Range of Healthcare Roles

Denver Health careers span a wide spectrum, from clinical roles in nursing and specialized medicine to administrative and support positions. As a teaching hospital, it offers a unique environment for professional growth, blending patient care with educational opportunities.

Available Job Opportunities

High-Demand Positions

Among the highest paying and most sought-after positions at Denver Health are Psychologist, Psychiatrist, and Licensed Therapist roles. This reflects the system's comprehensive approach to mental health services alongside its medical offerings.

Nursing and Clinical Staff

Opportunities in nursing and other clinical areas offer the chance to work directly with a diverse patient population. And of course, nursing and clinical staff are supported by state-of-the-art facilities and a network of community clinics.

Administrative and Support Roles

From medical billing specialists to healthcare administrators, Denver Health provides a variety of non-clinical positions essential to the smooth operation of the healthcare system.

Qualifications and Requirements

Ensuring the Highest Standards of Care

Denver Health seeks healthcare professionals who possess the necessary skills and experience and are committed to excellence in patient care and continuous learning.

Education and Certification

For clinical positions, specific degrees, certifications, and licenses are required, reflecting the level of expertise and specialization needed to meet the healthcare needs of the Denver community.

Application Process

Steps to Joining Denver Health

The journey to a career at Denver Health begins with a straightforward application process designed to identify candidates who align with the system's values and standards of care.

Submitting Your Application

Candidates can apply through Denver Health's online job portal, where current vacancies are listed. A detailed resume and cover letter tailored to the specific position are crucial components of the application.

Interview Tips and Techniques

Standing Out as a Candidate

Succeeding in the interview requires preparation and an understanding of what Denver Health values in its staff—a dedication to patient care, teamwork, and professional integrity.

Demonstrating Your Fit

Be ready to discuss how your skills, experience, and values align with the mission of Denver Health. Prepare examples from your past work that showcase your ability to contribute positively to the healthcare system.

Training and Development Programs

Commitment to Continuous Professional Growth

Denver Health offers extensive training and development programs, supporting its staff in achieving their highest potential and ensuring the delivery of top-quality care.

Advancing Your Skills

From on-the-job training to formal education programs, employees have opportunities to enhance their clinical skills, leadership abilities, and overall knowledge of healthcare practices.

Benefits and Compensation Packages

Rewarding Your Contribution

Denver Health offers competitive benefits and compensation packages, acknowledging the hard work and dedication of its employees with rewards that reflect their value to the healthcare system.

Comprehensive Benefits

Employees enjoy a range of benefits, including health insurance, retirement plans, and paid time off, alongside opportunities for bonuses and salary advancements based on performance and experience.

Employee Testimonials and Success Stories

From Our Staff to You

Hearing directly from Denver Health employees provides insight into the supportive work environment, career advancement opportunities, and the personal satisfaction derived from making a difference in the lives of patients.

Making an Impact

Employee stories highlight the rewarding nature of work at Denver Health, where every staff member plays a critical role in providing care and improving community health.

Career Advancement Opportunities

Pathways to Professional Development

Denver Health is committed to the career advancement of its employees, offering various pathways for professional development, from leadership roles within the nursing staff to specialized medical positions and administrative leadership.

Contacts and Resources for Further Information

Navigating Your Denver Health Career Path

For more detailed information about careers, the application process, or specific job openings at Denver Health, prospective applicants are encouraged to utilize the following resources:

Denver Health Careers Page

The primary resource for current job listings, application guidelines, and comprehensive information about working at Denver Health.

Further Assistance

For specific questions not addressed on the website, potential applicants can contact Denver Health's HR department directly through the provided contact details on the careers page.

Learn more about Denver Health

Size

7,000 employees

Industry