Job Description

The vision of Colorado Access is to have healthy communities transformed by the care that people want at a cost we can all afford. Our mission is to partner with communities and empower people through access to quality, affordable care.

Why should you consider a career with Colorado Access?

We are a Colorado-based company, working to improve the health of our state. We care for individuals, families, and children who receive health care under Child Health Plan Plus (CHP+) and Health First Colorado (Colorado's Medicaid Program). Our focus is driving improvements in quality, member experience, outcomes, and cost. We are a mission-driven organization whose foundation is built by our vision and supported by our values.

1. Find work/life balance: We offer PTO, floating holidays, nine company paid holidays, a hybrid work environment, an Employee Assistance Program and a 401K.
2. Be a part of something bigger and make an impact: We serve the underserved and most vulnerable populations in our community through access to quality and affordable health care. No matter what you do for Colorado Access, you are impacting our community and making a difference.
3. Sharpen your skills, learn, and grow: We support your continued development through tuition reimbursement, leadership training, promotion opportunities, performance evaluations, employee recognition, and a language pay stipend.

What you will do

We are looking for a SENIOR MEDICAL DIRECTOR who can help shape our vision and support our mission. Here is what the position will look like.

Job Specific Responsibilities:

• Provides enterprise-wide physician leadership across clinical programs and teams.
• Strengthens physician oversight of utilization management operations and clinical decision-making.
• Partners with Population Health, Care Management, and Behavioral Health to provide clinical guidance.
• Partners with Information Technology to provide clinical governance for artificial intelligence, technology, and automation affecting care and utilization management.
• Serves as a clinical advisor to multidisciplinary teams requiring physician expertise.
• Exercises independent judgment and escalates significant clinical or organizational risks as appropriate.
• Leads organizational change and transformation while building trust and strong cross-functional relationships.
• Builds high-performing teams through clear vision, leadership, goals, and performance measures.
• Leads cross-functional projects and continuous improvement initiatives across multiple departments.
• Oversees the development and implementation of departmental policies and procedures to ensure compliance with federal, state, local, and company requirements.
• Establishes, monitors, and applies criteria to ensure health care utilization meets member needs, aligns with community standards of care, and supports the efficient and appropriate use of health care resources.
• Oversee medical necessity determinations and clinical appeals of denied medical authorizations.
• Provides internal consultation and guidance regarding referrals, denials, appeals, and clinical process issues.
• Serves on the Credentials Committee may serve as chair and oversee the clinical aspects of the credentialing program.
• Participates in the Pharmacy and Therapeutics Committee and oversees automated drug-management review processes and their connection to appeals.
• Participates in provider and peer education related to medical management.
• Provides clinical leadership for complex case management programs, including care models for members with complex medical, behavioral health, social, and functional needs.
• Advises and partners with the Population Health department.
• Uses clinical, utilization, quality, cost, and population health data to identify trends, evaluate program performance, inform interventions, and support continuous improvement.
• Provides clinical guidance on predictive analytics, risk stratification, and other data-informed tools supporting utilization management, care management, quality improvement, and population health initiatives.
• Supports the governance, evaluation, and responsible use of artificial intelligence, automation, and clinical decision-support tools to promote transparency, fairness, accuracy, privacy, clinical validity, and compliance.
• Collaborates with operational and technology leaders to evaluate workflow optimization, automation, and data-driven decision support while maintaining appropriate medical oversight and accountability.

Senior Director Responsibilities:

• Provides strategic direction and oversees the management and maintenance of multiple department deliverables striving for operational excellence (productivity, quality, SLAs, customer experience of services provided, etc.). Builds high performing teams with vision, leadership, goals and metrics. Serves as a role model for team members; takes action and inspires team members to embrace and implement culture initiatives. Provides awareness to department leaders and staff how their work impacts other departments, programs and the enterprise. Encourages collaboration and holds team members accountable for achieving outstanding results.
• Responsible for all management functions including: hiring, training, planning and directing work, coaching and staff development, managing and evaluating performance, recognizing and rewarding employees, corrective action procedures and practices, addressing complaints and resolving problems. Develops and manages multiple department budgets.
• Works closely with Directors across the organization to make tactical and operational decisions that advance company strategies and goals and collaborates to deliver on company-wide deliverables/requirements.
• Oversees/leads projects and continuous improvement initiatives across multiple departments and/or cross-functional teams.
• Oversees the development and implementation of multiple department policies and procedures to ensure compliance with federal, state, local and company policies, rules and regulations.

What you will bring:

Education: Doctor of Medicine or Osteopathy with Board Certification, preferably in a primary care specialty or other relevant certification. Additional education such as Master’s Degree in healthcare related field is highly preferred.

Experience: Minimum of five years in healthcare and a minimum of two years of supervisory/leadership experience. Experience in utilization management, medical necessity review, complex case management, population health, quality improvement, or managed care clinical operations required. Experience using clinical, utilization, quality, cost, and population health data to guide decision-making and evaluate program outcomes preferred. Experience with clinical decision-support tools, predictive analytics, automation, artificial intelligence governance, or digital health initiatives preferred.

Knowledge, Skills, and Abilities: Ability to work independently, set priorities, manage multiple projects with tight deadlines, and contribute as a key member of the management team. Experience with strategic business planning, change management, people management, and project management. Ability to collaborate with colleagues and other health care professionals to resolve utilization and quality management issues. Ability to apply complaint, grievance, and appeal processes and procedures to facilitate quality outcomes and resolutions for members, providers, and Colorado Access. Demonstrates support for the company’s mission, vision and values. Excellent written, verbal, presentation, and public-speaking skills; bilingual communication skills in English and Spanish are preferred. Knowledge of utilization management, medical necessity criteria, appeals and grievances, peer review, accreditation standards, and managed care regulatory requirements. Ability to interpret clinical, utilization, quality, cost, and population health data and translate findings into actionable recommendations. Knowledge of public health principles, health equity, social drivers of health, prevention strategies, and population-based care models. Knowledge of complex case management models and approaches for members with high-risk, high-need, or medically complex conditions. Ability to provide clinical oversight for analytic tools, artificial intelligence and automation initiatives, and decision-support processes to support ethical, equitable, compliant, and clinically appropriate use.

Licenses/Certifications: Requires current medical licensing in the State of Colorado and Board certification. A valid driver's license and proof of current auto insurance will be required for any position requiring driving.

Together we will be: an innovative and collaborative team who supports each other, the employees and vision of the company to reach our goals individually, together and as an organization.

Pay, Perks and Benefits at Colorado Access:

The compensation for this position is $300,000.00 - $350,000.00 annually. Colorado Access has provided a compensation range that represents its good faith estimate of what Colorado Access may pay for the position at the time of posting. Colorado Access may ultimately pay more or less than the posted compensation range. The salary offered to the selected candidate will be determined based on factors such as the qualifications of the selected candidate, departmental budget availability, internal salary equity considerations, and available market information, but not based on a candidate’s sex or any other protected status.

In addition to being part of a mission driven organization serving our community, as an eligible Colorado Access employee, you’ll receive a generous benefits package, that includes:

• Medical, dental, vision insurance that starts the first day of the month following start date.
• Supplemental insurance such as critical illness and accidental injury.
• Health care and dependent care flexible spending account options.
• Employer-paid basic life insurance and AD&D (employee, spouse and dependent).
• Short-term and long-term disability coverage.
• Voluntary life insurance (employee, spouse, dependent).
• Paid time off
• Retirement plan
• Tuition reimbursement (based on eligibility).
• Annual bonus program (based on eligibility, requirements and performance).

Where you will work:

This position will be a hybrid model work environment, a blend of ‘In-Office’ and ‘Remote.’

We are not able to support out of state employees at this time as we continue to serve our members and community in the metro Denver area and across the beautiful state of Colorado.

Colorado Access is committed to providing equal opportunities to all people regardless of race, color, national origin, age, sex, genetic information, religion, pregnancy, disability, sexual orientation, veteran status or any other status protected by applicable law. We strive to maintain a work environment that is free from unlawful harassment and discrimination.