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, supported by our values and pillared by diversity, equity and inclusion.

1. Find work/life balance: We offer PTO, floating holidays, seven company paid holidays, work from home options (exceptions apply), 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 Utilization Service Coordinator like you who can help shape our vision and support our mission. This position will be Monday - Friday from 8AM -5PM (daytime hours). Here is what the day-to-day functions will look like:

• Responsible for all aspects (i.e. documentation, authorization letters, etc.) regarding authorizations, utilization management and coordination of inpatient acute care, sub-acute, outpatient care, rehabilitation services, and home health care for consumers accessing physical health and/or behavioral health benefits. Facilitates and coordinates discharge planning and works towards reduction of preventable hospital admissions, re-admissions, excessive therapies, DME, etc.
• Interfaces with network providers regarding consumer service plans and care coordination. Participates in the evaluation and integration of wrap around services in relation to the overall service plan which may involve travel to attend meetings regarding consumer care or the system of care.
• Works closely with the Supervisor of Behavioral Health Utilization Management to identify and solve problems related to providers, provider networks, access to and availability of services.
• Supports quality improvement activities. Reports potential quality issues and concerns to the Medical Director and the Quality Management department.
• Performs onsite and/or telephonic concurrent reviews of inpatient and outpatient episodes of care. Gathers pertinent clinical information and applies/interprets criteria to ensure medical necessity, covered benefits, participating providers and appropriate services. Refers cases not meeting approved criteria/guidelines to the Medical Director for determination.
• Works closely with other teams within the Coordinated Clinical Services department to ensure that departmental goals are met.
• Responsible for effective collaboration, communication and coordination among all responsible parties of an individual member's multidisciplinary health care team striving to eliminate fragmentation, duplication or gaps in treatment plans.
• Understands, communicates and facilitates on behalf of the consumer, providers and other ancillary suppliers the complaint, grievance and appeal processes. Advises on the existing resources such as "Member's Handbook" and "Provider Manual".
• Facilitates and engages in ongoing, real time, and comprehensive communications of their efforts, issues, progress, and barriers with other CCS Staff, Supervisors and Managers.

What you will bring:
Education: Bachelor’s degree in nursing or a behavioral health related field required, or an equivalent combination of education and experience; Master’s degree preferred.

Experience: Three years of clinical case management and healthcare experience in the physical or behavioral setting required. Experience working with Managed Care, Medicaid and Medicare populations is preferred. Experience with concurrent review, quality improvement processes, ICD9, CPT4 and DRG coding preferred.
Knowledge, Skills, and Abilities: Knowledge of managed care and utilization management required. Demonstrates support for the company’s mission, vision and values. Position requires excellent written and verbal and written communication skills, strong organizational and time management skills, strong interpersonal skills and the ability to handle multiple priorities. Ability to work independently with minimal supervision. Ability to work effectively with Colorado Access staff, members, physician office staff and other providers. Requires basic computer knowledge with experience in Microsoft Word and Excel preferred. May be required to manage multiple priorities and projects with tight deadlines.

Licenses/Certifications: Active Colorado Nursing (i.e. RN, LPN) or Mental Health licensure (i.e. LCSW, LPC) required or a combination of experience and education can substitute for a period of one year while the license is being obtained. Certified Addictions Counselor Certification preferred. A valid driver's license and proof of current auto insurance will be required.

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 $65,000.00 to $85,000.00 annually. The pay rate/salary is commensurate with experience.

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 an offsite model work environment. Approximately 80%-100% offsite, not at the office.

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.

COVID-19 Vaccination Notice:
In compliance with state and federal guidance, Colorado Access has adopted a policy addressing vaccination and testing requirements to protect the health of employees and their families, our members, vendors and visitors of Colorado Access. All new hires must present proof of COVID-19 vaccinations or agree to testing protocols at the time of hire.

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.


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