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.
Find work/life balance: We offer PTO, floating holidays, nine company paid holidays, a hybrid work environment, an Employee Assistance Program and a 401K.
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.
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,…