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

Denver Health and Hospital Authority • Denver, CO

3d • Hybrid

About The Position

The Care Management Transition of Care Team Manager is a leadership role within Denver Health Medical Plan, responsible for coordinating members’ transitions from acute care settings—including hospitals, emergency departments, and skilled nursing facilities—to home, outpatient, or post-acute care. The role focuses on safe, evidence-based, member-centered transitions that reduce readmissions, improve outcomes, and support value-based care.

The manager leads a team of nurse care managers, overseeing caseloads, performance, coaching, and quality assurance. The position develops and continually improves transition-of-care workflows, monitors key measures such as timely post-discharge follow-up and program enrollment, and prioritizes members at high risk. The manager also coordinates with inpatient teams, utilization management, providers, and community-based services to address members’ needs.

This is a hybrid role in Denver, Colorado, requiring three days per week in the office. Candidates must live in Colorado. The work schedule is days, and the position is regular employment.

Requirements

• Associate’s degree in Nursing.
• 1–3 years of health plan or hospital-based care management experience.
• 1–3 years leading a team of nurses or care managers; supervisory or leadership experience is mandatory.
• Must live in Colorado.
• Ability to understand the needs of safety-net populations with complex care needs.
• Skill 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.
• Data analysis and quality improvement skills, including PDSA and root-cause analysis.
• Strong mentorship and team-development capabilities.
• Ability to collaborate with cross-functional teams on initiatives with shared goals.

Nice To Haves

• Bachelor’s degree in Nursing.
• APRN-Certified Nursing Administration certification from AONL, RN-ANCC Ambulatory Care Certification, or CCM-Certified Case Manager certification.

Responsibilities

• Delegate and oversee nurse care managers’ caseloads, productivity, outcomes, and key performance indicators.
• Analyze clinical data to identify gaps and cost drivers, and lead process improvements.
• Partner with hospital systems, accountable care organizations, and post-acute care providers to establish standardized communication pathways.
• Oversee identification of high-risk members and implement strategies to mitigate transition-related risks.
• Ensure timely post-discharge follow-up, including appointment scheduling, program enrollment, coordination with home health, rehabilitation or social services, and member education on self-management and warning signs.
• Assist with root-cause analysis of readmissions and adverse events related to transition-of-care failures.
• Monitor and report measures including 30-day readmission rates, time to first follow-up, and member and provider satisfaction.
• Ensure transition-of-care activities comply with CMS requirements, MAC guidelines, and plan policies.
• Keep current with transition-of-care regulations and innovations, and support internal and external audits of processes and documentation.
• Build and maintain relationships with hospital discharge planners, care managers, emergency department leadership, and post-acute care facilities.
• Promote transition-of-care best practices and communicate health plan programs and resources.
• Collaborate with utilization management, pharmacy, and health outcomes teams to address barriers to care.
• Mentor and develop clinical staff through coaching and performance feedback.
• Develop, implement, and continuously refine transition-of-care workflows and protocols.

Benefits

• Paid time off starting at 28 days per year, including vacation, personal/sick time, and seven holidays.
• Fully paid parental leave for up to six weeks.
• Retirement plans with employer contributions up to 9.5%.
• Medical, dental, and vision coverage.
• Employer-paid disability and life insurance.
• Well-being programs, including an on-site employee fitness center and RESTORE Center.
• Free RTD EcoPass for public transportation.
• Childcare discount programs and discounts on brands, travel, and other perks.
• Tuition reimbursement and assistance.
• Education, coaching, and professional development opportunities through the Workforce Development Center.
• Career advancement pathways and a professional clinical advancement program with shared governance.
• Public Service Loan Forgiveness-eligible employer, with student loan coaching and assistance navigating the program.
• Eligibility for National Health Service Corps and Colorado Health Service Corps programs.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Education Level: Associate degree