Manager, Care Management Transition of Care Team - Denver Health Medical Plan

Denver Health•Denver, CO

3d•Hybrid

About The Position

We are recruiting for a mission-driven Manager, Care Management Transition of Care Team - Denver Health Medical Plan 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 This position will require 3 days in-office 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.

Requirements

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

Nice To Haves

Bachelor's Degree Nursing preferred

Responsibilities

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
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
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
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

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.
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