Colorado HealthOP in Denver, Colorado is a new and exciting consumer-governed, private, nonprofit health insurance plan designed to improve consumer choice, enhance competition, and promote integrated models of care. The CO-OP (Consumer Oriented and Operated Plan) will operate under the Patient Protection and Affordable Care Act with a consumer-elected board. The primary purpose of Colorado HealthOP is to expand access to affordable, quality health care for Colorado residents through an unprecedented level of consumer, provider, and community engagement in health promotion and management. It will strive to improve access to health resources in all communities in Colorado, with an emphasis on the rural areas of the state.
This is a unique opportunity to be in on the ground floor of something awesome! Colorado HealthOP is changing the way that Coloradoan's are insured and we want you to be a part of our growing team.
In exchange for your passion, we are offering amazing potential as our tiny organization grows; an opportunity to work in an entrepreneurial, start-up environment; 100% employer paid health, dental, and vision insurance; and conference/ educational reimbursement (because we want you to grow as the organization grows).
Colorado HealthOP is seeking a Manager of Clinical Care to be responsible for the following:
- Works with Chief Medical Officer, Chief Operating Officer, and Director of Technology to implement and provide oversight of clinical case management procedures with the CO-OP’s Third Party Administrator (TPA) vendor.
- Develops staffing and training plans for utilization management and disease management functions.
- Works with Chief Strategy Officer, Chief Operations Officer, and Chief Medical Officer to develop programs for identifying provider and member issues related to clinical case management and identifying solutions for ongoing operations.
- Identifies and implements other strategies that insure quality care, access to care, and the financial success of the cooperative.
- Participates in appropriate meetings on health CO-OPs at the federal, state, and local levels, and with CO-OP national trade organizations to share information and identify best practices for Colorado HealthOP.
- Plans and coordinates projects and tasks for NCQA accreditation related to areas of case management, utilization management and review, disease management, and other areas as assigned. Serves as primary liaison with Case Management vendors for member clinical care and accreditation purposes.
Desired Skills and Experience
- 8+ years of broad medical management leadership experience in a health insurance organization
- Licensed Registered Nurse
- Ability to identify, design, drive, and evaluate clinical care management programs, meet deadlines, and make changes as needed
- Ability to communicate and influence a variety of constituents
- Knowledge of health care cooperatives and their differentiation in the market
- Knowledge of Colorado’s health insurance market