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

Denver Health•Denver, CO

8d•$101,300 - $162,100•Hybrid

About The Position

The Care Management Transition of Care Team Manager is a leadership role within Denver Health Medical Plan, responsible for supporting seamless transitions of members from acute care settings—including hospitals, emergency departments, and skilled nursing facilities—to home, outpatient, or post-acute care. The role promotes coordinated, evidence-based care during high-risk transitions to reduce readmissions, improve outcomes, and align with value-based care models. The manager leads and develops a team of nurse care managers specializing in transitions of care, including assigning caseloads, providing coaching and performance feedback, and overseeing quality assurance and productivity and outcome measures. The position develops, implements, and continually refines transition-of-care workflows, prioritizing high-risk members and proactive coordination with inpatient teams and health plan utilization management. Key measures include timely post-discharge follow-up and enrollment in the transition-of-care program. This is a hybrid position based in Denver, Colorado. The employee must live in Colorado and work in the office three days per week. The role is a regular day-shift position.

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.
Deep understanding 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 organizational initiatives with shared goals.
Must live in Colorado.

Nice To Haves

Bachelor's degree in Nursing.
APRN-Certified Nursing Administration certification from AONL (American Organization for Nursing Leadership).
AMBRNBC-Ambulatory Care Certification RN from ANCC (American Nurses Credentialing Center).
CCM-Certified Case Manager certification from ANSI (American National Standards Institute).

Responsibilities

Delegate nurse care manager caseloads and supervise the team, including oversight of productivity and outcome KPIs.
Analyze clinical data to identify care gaps and 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 and implement strategies to mitigate 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 30-day readmission rates, time to first follow-up, member satisfaction, and provider satisfaction.
Ensure transition-of-care activities comply with CMS requirements, MAC guidelines, and plan-specific policies.
Stay current with transition-of-care regulations and innovations to support compliance and improve team practices.
Support internal and external audits related to transition-of-care 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 transition-of-care and other care management programs and resources.
Collaborate with utilization management, pharmacy, and health outcomes teams to address barriers to care.

Benefits

Paid time off starting at 28 days per year, inclusive of vacation, personal/sick time, and seven holidays.
100% paid parental leave for up to six weeks.
Retirement plans with immediate eligibility and employer contributions up to 9.5%.
Medical, dental, and vision plans.
Employer-paid disability and life insurance.
Well-being programs, including an on-site employee fitness center and the 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.
Professional clinical advancement program and shared governance.
Public Service Loan Forgiveness-eligible employer, with free student loan coaching and assistance navigating the program.
National Health Service Corps and Colorado Health Service Corps eligible employer.