Utilization Management (UM) Contract Manager and Operations Unit Supervisor

About the Department

STATE OF COLORADO RESIDENCY REQUIRED AT TIME OF APPLICATION

Note: This announcement may be used to fill multiple openings.

Envision Yourself Working at HCPF

The State of Colorado strives to create a Colorado for All by building and maintaining workplaces that value and respect all Coloradans through a commitment to equal opportunity and hiring based on merit and fitness. The State is resolute in non-discriminatory practices in everything we do, including hiring, employment, and advancement opportunities.

The Department of Health Care Policy & Financing (HCPF) oversees and operates Health First Colorado (Colorado's Medicaid Program), Child Health Plan Plus (CHP+), and other state public health programs for qualified Coloradans. Our mission is to improve health care equity, access and outcomes for the people we serve while saving Coloradans money on health care and driving value for Colorado. 

We are looking for a Utilization Management (UM) Contract Manager and Operations Unit Supervisor for the Clinical Operations Division of the Cost Control and Quality Improvement Office (CCQI)!

The Clinical Operations Division of CCQI works across various HCPF Offices to offer clinical expertise and consulting across the entirety of HCPF. The Clinical Operations Division has oversight of HCPF’s third-party utilization management (UM) vendor for any selected outpatient fee-for-service prior authorizations, as well as the Physician Administered Drugs (PAD) program. This division is also responsible for the administration of the Nurse Advice Line (NAL) Program and the Inpatient Hospital Transitions (IHT) program. The UM program is continuously reviewing opportunities to reduce provider friction and burden, improve member experience, enhance quality, reduce costs, and increase efficiencies via strong partnerships across HCPF, stakeholders, vendors, and the Regional Accountability Entities (RAEs) which enhance care management opportunities.

We are committed to increasing the diversity of our staff and providing culturally responsive programs and services. Therefore, we encourage responses from people of diverse backgrounds and abilities.

As part of the State of Colorado, HCPF offers a competitive benefits package:

• PERA retirement benefits including PERA Defined Benefit Plan, PERA Defined Contribution Plan, plus 401K and 457 plans

• Medical, Dental, and Vision insurance coverage

• Automatic Short-Term and Optional Long-Term Disability Coverage

• Life and AD&D Insurance

• Flexible Spending Accounts (FSAs)

• Family Medical Leave Act (FMLA) job protection and State of Colorado Paid Family Medical Leave (PFML)

• 11 Paid Holidays Annually and Accrued Annual and Sick Leave

• Accrued Sick Leave for State of Colorado Temporary Employees

• Flexplace and Flextime work arrangements

• Variety of discounts on services and products available through the State of Colorado's Work-Life Employment Discount Program

• Free RTD EcoPass to all eligible State Employees

• Reduced college tuition through CSU Global

• Credit Union of Colorado Membership Eligibility

• Some positions may qualify for the Public Service Loan Forgiveness Program. For more information, go to https://www.colorado.gov/pacific/dhr/student-loan-forgiveness-programs.https://dhr.colorado.gov/dhr-resources/student-loan-forgiveness-programs

We are onboarding new employees using a hybrid approach. The Department supports flexible work arrangements. Depending on the business need and description of the position, we have options that range from hybrid to full-time in the office. Specific discussions about the schedule will be discussed during the offer stage. 

**Please note - equipment provisioning and certain onboarding tasks will take place in person, in our downtown Denver office, on the first day of employment.**

Position Duties

What You’ll Be Doing as UM Contract Manager and Operations Unit Supervisor:

• Provides management and oversight for all the Utilization Management (UM) related contracts and vendor agreements assigned to the UM section including tracking of all vendor scopes of work and approval of vendor deliverables.

• Supervises the operations staff and responsible for the Clinical Operations contract management duties.

• Ensures all aspects of the UM Program meet operational and programmatic goals and compliance with all federal and state requirements.

• Direct oversight of the UM contract including new duties associated with external stakeholder and public relations including the Governor’s Office, large provider groups, hospitals, lobbyists, and advocates.

• Manages, tracks, and investigates all vendor performance complaints submitted by both internal staff and external stakeholders.

• Uses knowledge not otherwise available at HCPF of UM activities, best practices, and HCPF goals to enhance, develop and implement guidelines around contracting and vendor management.

• Reviews the contracts and programs to identify opportunities, potential risks, timelines, and deliverables to meet HCPF’s directives, goals, deadlines, and budget objectives.

• Completes data requests that are crucial to informing staff and senior management of trends, problems, and inform strategic planning initiatives in CCQI for HCPF.

• Provides support to the Clinical team regarding administration and compliance of the NAL contract.

• Responds to internal and external ad-hoc information requests, maintains formal contract administration files, and participates in appropriate committees and meetings.

Minimum Qualifications

Residency Requirement: 

This posting is only open to residents of the State of Colorado at the time of submitting your application. 

Class Code & Classification Description:

H1A2XX

PROGRAM MANAGEMENT I

MINIMUM QUALIFICATIONS:

There are two ways to qualify for this position:

Option 1:

Experience Only:

Eight (8) total years of professional experience in contract management, healthcare operations supervision, stakeholder engagement, or a related field.

Option 2:

Education and Experience:

Bachelor's degree from an accredited institution in Business administration, Legal studies, Public health, Health administration, or a related field

AND

Four (4) total years of professional experience in contract management, healthcare operations supervision, stakeholder engagement, or a related field.

Appropriate education will substitute for the required experience on a year-for-year basis. Relevant education will be calculated as the following:

• An associates will count as two years of experience

• A bachelors will count as four years of experience

• A masters degree will count for six years of experience

• A doctorate or juris doctorate degree will count for seven years of experience

Note: Per the Job Application Fairness Act, you may redact information that identifies your age, date of birth, or dates of attendance at or graduation from an educational institution on your transcripts.

PREFERRED QUALIFICATIONS

• Previous relevant professional state experience

• Masters degree in business, public health, law, or health administration

• Professional experience in:

  • Program Management

  • Medicaid and/or Managed Healthcare Organization

Skills to Support Success

• Positivity

• Strong communication skills

• Adaptability

• Analytical nature

• Activator

• Strategic thinker

• Deliberative

• Focused on staff development

Definition of Professional Experience: Work that involves exercising discretion, analytical skill, judgment, personal accountability, and responsibility for creating, developing, integrating, applying, and sharing an organized body of knowledge that characteristically is uniquely acquired through an intense education or training regimen at a recognized college or university; equivalent to the curriculum requirements for a bachelor's or higher degree with major study in or pertinent to the specialized field; and continuously studied to explore, extend, and use additional discoveries, interpretations, and application and to improve data, materials, equipment, applications and methods. 

Conditions of Employment

• All positions at HCPF are security sensitive positions and require that the individuals undergo a criminal record background check as a condition of employment.

• Employees who have been disciplinary terminated, resigned in lieu of disciplinary termination, or negotiated their termination from the State of Colorado must disclose this information on the application.

 

Appeal Rights:

If you receive notice that you have been eliminated from consideration for this position, you may file an appeal with the State Personnel Board or request a review by the State Personnel Director.

An appeal or review must be submitted on the official appeal form, signed by you or your representative. This form must be delivered to the State Personnel Board by email ([email protected]), postmarked in US Mail or hand delivered (1525 Sherman Street, 4th Floor, Denver CO 80203), or faxed (303.866.5038) within ten (10) calendar days from your receipt of notice or acknowledgement of the department’s action.

For more information about the appeals process, the official appeal form, and how to deliver it to the State Personnel Board; go to spb.colorado.gov; contact the State Personnel Board for assistance at (303) 866-3300; or refer to 4 Colorado Code of Regulations (CCR) 801-1, State Personnel Board Rules and Personnel Director's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes, at spb.colorado.gov under Rules.

Other Qualifications

How to Apply (Please Read Carefully)

Please note that ONLY your State of Colorado job application will be reviewed during the initial screening; if you submit a resume and cover letter, they will be reviewed in later stages of the selection process. Therefore, it is paramount that you clearly describe all your relevant experience on the application itself. Applications left blank or marked "SEE RESUME" will not be considered.

Your application will be reviewed against the minimum qualifications for the position. If your application demonstrates that you meet the minimum qualifications, you will be invited to the comparative analysis process, which is described below.

Comparative Analysis Process

The comparative analysis process will consist primarily of a review of applications against the minimum and preferred qualifications of this position. Applications will be reviewed in comparison to all others in the applicant pool in order to identify a top group of candidates who may be invited for a final interview. Depending on the size of the applicant pool, additional selection processes may be utilized to identify a top group of candidates. Applicants will be notified of their status via email.

Failure to submit properly completed documents by the closing date will result in your application being rejected.

ADAAA Accommodations

The State of Colorado believes that equity, diversity, and inclusion drive our success, and we encourage candidates from all identities, backgrounds, and abilities to apply. The State of Colorado is an equal opportunity employer committed to building inclusive, innovative work environments with employees who reflect our communities and enthusiastically serve them. Therefore, in all aspects of the employment process, we provide employment opportunities to all qualified applicants without regard to race, color, religion, sex, disability, age, sexual orientation, gender identity or expression, pregnancy, medical condition related to pregnancy, creed, ancestry, national origin, marital status, genetic information, or military status (with preference given to military veterans), or any other protected status in accordance with applicable law.

The Department of Health Care Policy & Financing is committed to the full inclusion of all qualified individuals. As part of this commitment, our agency will assist individuals who have a disability with any reasonable accommodation requests related to employment, including completing the application process, interviewing, completing any pre-employment testing, participating in the employee selection process, and/or to perform essential job functions where the requested accommodation does not impose an undue hardship. If you have a disability and require reasonable accommodation to ensure you have a positive experience applying or interviewing for this position, please direct your inquiries to our ADAAA Coordinator, Anupreet Kaur, at [email protected].

The Department of Health Care Policy & Financing does not offer sponsored visas for employment purposes.

Benefits

The State of Colorado offers permanent employees a variety of benefits including medical, dental, life and disability insurance, as well as a comprehensive leave program.  Please click the following link for detailed information:  www.colorado.gov/pacific/dhr/benefits 

Please note that each agency's contact information is different; therefore, we encourage all applicants to view the full, official job announcement which includes contact information and class title. Select the job you wish to view, then click on the "Print" icon.
 

Supplemental Questions

Required Question

Agency Information

EmployerState of ColoradoAddress See the full announcement by clicking
the "Printer" icon located above the job title
Location varies by announcement, Colorado, -- Website https://careers.colorado.gov/