We are recruiting for a mission-driven Manager, Care Management Transition of Care Team - Denver Health Medical Plan to join our team!

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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.

Essential Functions:

• Transition of Care Leadership & Strategy:
  - 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 (15%)
• Clinical Coordination & Quality Improvement:
  - 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 (30%)
• Compliance & Regulatory Alignment:
  - 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 (30%)
• Stakeholder Engagement:
  - 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 (25%)

Education:

• Associate's Degree Nursing required
• Bachelor's Degree Nursing preferred

Work Experience:

• 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

Licenses:

• 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

Knowledge, Skills and Abilities:

• 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)<