Manager, Care Management Transition of Care Team Denver Health Medical Plan (Must Live in Colorado. Weekly On-Site Requirement)

Were with you for lifes journey. At Denver Health purpose isnt just something we believe inits something we live every day for lifes journey.

Our Values

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Department

* Must Live in Colorado

* This a hybrid role located in Denver Colorado with a requirement of being in the office 3 days per week.

Job Summary

The Care Management Transition of Care Team Manager is a pivotal leadership role within the Denver Health Medical Plan driving excellence in the seamless transition of members from acute care settings (hospitals emergency departments skilled nursing facilities) to home outpatient or post-acute care. This role ensures coordinated evidence-based care during high-risk transitions to reduce readmissions improve outcomes and align with value-based care models. As a leader you will mentor clinical staff optimize TOC protocols and collaborate with providers to create a member-centered continuum of care. Core responsibilities include development implementation and continuous refinement of TOC workflow. This role with lead a team of nurse care managers specializing in TOC providing coaching performance feedback and quality assurance. Key metric monitoring includes timely post-discharge follow up and enrollment in the TOC program. Workflows are outcomes oriented and work will prioritize identification of high-risk members proactive coordination of care with inpatient teams and health plan utilization management to meet member needs.

Essential Functions:

• Transition of Care Leadership & Strategy:
  - Delegation of TOC nurse care managers caseloads providing supervision and oversight of KPIs for productivity and outcomes
  - Analysis of clinical data to identify gaps cost-drivers and lead process improvements
  - Partner with hospital systems ACOs and post-acute care providers to establish standardized communication pathways (15%)
• Clinical Coordination & Quality Improvement:
  - Oversee proactive identification of high-risk members (e.g. chronic conditions frequent ED utilizers at risk for readmissions) and implement mitigation strategies
  - Ensure timely post-discharge follow-up which may include appointment scheduling program enrollment coordination with home health rehabilitation or social services and provide member education related to self-management and warning signs
  - Assist with root-cause analysis of readmissions and adverse events related to TOC failures
  - Monitor and report key metrics including: 30-day readmission rates time-to-first follow up member satisfaction and provider satisfaction (30%)
• Compliance & Regulatory Alignment:
  - Ensure all TOC activities comply with CMS requirements MAC guidelines and plan-specific policies
  - Stay current with evolving TOC regulations and innovations to ensure compliance and enhance team practices
  - Support audits (internal/external) related to TOC processes and documentation (30%)
• Stakeholder Engagement:
  - Build and maintain strategic relationships with hospital discharge planners care managers emergency department leadership and post-acute care facilities
  - Be a spokesperson for TOC best practices and socialize health plan TOC and other care management programs and resources
  - Collaborate with utilization management pharmacy and health outcomes teams to address barriers to care (25%)

Education:

• Associates Degree Nursing required
• Bachelors Degree Nursing preferred

Work Experience:

• 1-3 years Health plan or hospital-based care management required
• 1-3 years leading a team of nurses or care managers (supervisor or leadership experience mandatory) required

Licenses:

• Preferred Certifications:

• APRN-Certified Nursing Administration - AONL - American Organization for Nursing Leadership OR
• AMBRNBC-Ambulatory Care Certification RN - ANCC - American Nurses Credentialing Center OR
• CCM-Certified Case Manager - ANSI - American National Standards Institute
  

Knowledge Skills and Abilities:

• Deep understanding of the safety net populations with complex care needs
• Skills navigating acute post-acute and community-based resources to support transitions of care
• Proficiency reviewing clinical information from EHRs and care management software systems
• Familiarity with CMS regulations
• Facile data analytic skills and quality improvement (e.g. PDSA root-cause analysis)
• Strong mentorship and team development capabilities
• Ability to collaborate with cross-functional teams on organizational initiatives with shared goals

* Must Live in Colorado

* This a hybrid role located in Denver Colorado with a requirement of being in the office 3 days per week.

Shift

Work Type

Salary

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 youre 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 is an integrated high-quality academic health care system considered a model for the nation that includes a Level I Trauma Center a 555-bed acute care medical center Denvers 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 Colorados primary and essential safety-net health care 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.