State Of Colorado Residency Required At Time Of Application

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

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 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.

We are looking for a Part-Time RAC Program Medical Director to join our Cost Control and Quality Improvement team!

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
• 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.

Description Of Job

What you’ll be doing:

• Provides medical judgment regarding all medical and clinical issues proposed by the Colorado Recovery Audit Contractor Program (RAC) and Department Staff overseeing this program.
• Provides clinical input after audits on the following types of claims: Health First Colorado fee-for service, waiver services, managed care, and Child Health Plan Plus (CHP+) claims.
• Supports post-payment claims reviews for provider-submitted Health First Colorado paid claims to determine whether services were actually provided, medically necessary, coded correctly, and properly paid or denied.
• Testifies at Administrative Law Judge client hearings regarding medical necessity determination. Oversees the activities of any areas under their jurisdiction.
• Serves on the Department’s Executive Leadership Team.
• Develops and presents solutions to complex problems which typically involve unique Medicaid law.
• Directly and through the work of others, bridges differences of policy, opinion, and desire to find workable solutions to Colorado’s most pressing health care issues.
• Reviews and approves clinical aspects of audit scenarios proposed by the RAC contractor.
• Reviews and determines disposition of complex reviews at the appeal stage for clinical appropriateness and directs withdraw of the demand when clinically appropriate.
• Monitors both exit conferences on an intermittent basis and monitors the informal reconsideration process to assure contractor is meeting Departments standards and making clinically defensible determinations.

Minimum Qualifications, Substitutions, Conditions Of Employment & Appeal Rights

Residency Requirement: (New)

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

Class Code & Classification Description: (New)

C1K1XX PUBLIC HEALTH MEDICAL ADMINISTRATOR I

Education/Licensure/Certification/Experience

MINIMUM QUALIFICATIONS:

• Education: Medical degree, MD or DO.
• Licensed to practice medicine in the State of Colorado or eligible for such license.
• Experience: Two (2) years of experience in an occupational field related to the work in utilization management or auditing

Special Qualifications:

• Degree of Doctor of Medicine or Doctor of Osteopathy and be licensed to practice medicine in the State of Colorado. Unrestricted license to practice medicine in the State of Colorado.

ONLY APPLICANTS WHO MEET THE SPECIAL QUALIFICATIONS SHALL BE CONSIDERED FOR THIS ANNOUNCEMENT.

Preferred Knowledge, Skills And Abilities

• General familiarity with standard coding guidelines for inpatient and outpatient care
• Awareness and insight into nationally accepted clinical care guidelines specific to inpatient medical necessity
• Expert communicator with ability to identify trends and address aberrancies while promoting trust and collaboration

Preferred Qualifications:

• Hospital-based clinical provider experience
• Master’s degree in public health, public health administration or health administration
• Prior state experience related to the duties of this position

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: (Updated)

An applicant who has been removed from an employment list or removed from consideration during the selection process may request a review by the State Personnel Director.

As an applicant directly affected by the results of the selection or comparative analysis process, you may file a written appeal with the State Personnel Director.

Review of the completed, signed and submitted appeal will be timely on the basis of written material submitted by you, using the official appeal form signed by you or your representative. This form must be completed and delivered to the State Personnel Board by email at [email protected] within ten (10) calendar days from your receipt of notice or acknowledgement of the Department’s action.

For further information on the Board Rules, you can 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/board-rules .

Supplemental Information

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, Virginia Miller, at [email protected] .