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

Denver Health -
Denver, CO

Apply Now

Job Details

Full-time
$143,800 - $237,400 a year

Benefits

Paid parental leave
Paid holidays
Disability insurance
Health insurance
On-site gym
Dental insurance
Tuition reimbursement
Paid time off
Parental leave
Vision insurance
Employee discount
Loan forgiveness
Life insurance
Childcare
Retirement plan

Qualifications

Affordable Care Act (ACA)
Financial modeling
Medicare
Team supervision
Managed care organization experience
Contract management experience in healthcare
Medicaid health insurance
ICD-9
HCPCS
Bachelor's degree
Medicare regulations
Direct contracting
Centers for Medicare and Medicaid Services (CMS)
Contracts
Medicaid regulations
Medicaid
Healthcare reimbursement methods
Senior leadership

Full Job Description

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

We're with you for life’s journey. At Denver Health, purpose isn’t just something we believe in—it’s something we live every day, for life’s journey.

Our Values

Respect | Belonging | Accountability | Transparency

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

Under the general supervision of the CFO, the Senior Director of Provider Contracting is responsible for developing and implementing new and established contracts for facility and professional agreements with providers on behalf of Denver Health Medical Plan, including new programs and services. This role will lead negotiations with providers to include payment terms based on multiple reimbursement models, including fee-for-service payment terms, valued based payments, and gain/risk sharing arrangements. The Senior Director will be accountable for negotiating contract language that aligns with all State and Federal laws/regulations and organizational policies. This position will be responsible for development of practices consistent with the mission and vision of Denver Health Medical Plan.

Essential Functions :

Oversee organizational contract development and management activities and enforce organizational principles of integrity and compliance (15%)
Develop standards for contracts, including payment terms, general language and provisions based on strategy discussions, senior management input and organizational needs (15%)
Evaluate rate proposals, changes to reimbursement methodologies and conduct related analyses to ensure continued financial viability of the contract (10%)
Ensure contracts and proposals are properly entered into organizational databases to measure, track and monitor utilization and financial performance (10%)
Negotiate single case agreements as needed (5%)
Serve as primary organizational contact during provider contract negotiations (10%)
Identifies network needs and manages the recruitment and contracting process for new providers and institutions (5%)
Ensure prompt resolution of all escalated concerns or issues from the Plan’s provider network (5%)
Participate in JOC meetings with providers to address contractual payment issues and trends (5%)
Validate the proper uploading, adjudication, and pricing of claims (5%)
Maintain knowledge and understanding of healthcare industry trends, standards, and current events relative to provider contracting, network administration and market (5%)
Carry out supervisory responsibilities in accordance with the organization’s policies and applicable laws. Responsibilities include interviewing, hiring, and training employees; planning, assigning and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems (5%)

Education :

Bachelor's Degree, concentration in Finance, Accounting, Business, Management, Healthcare Administration related field required

Work Experience :

10+ years Contract Management demonstrated experience required; provider contracting experience preferred required
4-6 years manager experience required , preferably in healthcare required

Licenses :
Knowledge, Skills and Abilities :

Strong knowledge of Medicaid, Commercial ACA, Medicare, and CHP+ lines of business is required
Knowledge of CPT, ICD-9 and 10, DRG, HCPCS, RBRVS, bundled payments, risk-sharing, and provider capitation is essential
Extensive knowledge and experience with Medicare/Medicaid regulations
Excellent negotiating skills and proficiency in utilizing and interpreting financial models and analysis
Requires high attention to detail, analytical and critical thinking, management skills, organization, prioritization and problem resolution
Excellent verbal and written communication, leadership, delegation, collaboration and interpersonal skills
Ability to be resourceful, customer-service oriented and independently problem solve is required

* 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 - $237,400.00 / 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

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.

Apply Now

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

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