Job description


  • Entry level
  • No Education
  • Salary $86,688.00 - $105,000.00 gross per year
  • Denver


Department Information

Make a difference-Join HCPF by improving health care access and outcomes for the people we serve while demonstrating stewardship of financial resources.

The Department of Health Care Policy and Financing (Department) offers a competitive benefits package to include the Public Employees Retirement Account (PERA), 401k/457, health/dental insurance options, 10 paid holidays, accrual of paid sick and vacation/annual time. The Department is also centrally located; offers affordable ECO passes; has a fitness center on-site; and a variety of discounts on services and products are available to state employees through the State of Colorado's Work-Life Employment Discount Program. The Department also encourages employees to take advantage of advanced education and offers reduced college tuition through CSU Global for their employees. This Department is a "Tobacco Free Workplace".

Cost Control & Quality ImprovementOffice
The Cost Control & Quality Improvement Office was established on July 1, 2018 by the Medicaid Cost Containment bill (SB18-266). Positions inside this new Office may focus on the analysis of or efficiency and quality opportunities in utilization, unit cost, quality and overall cost trends inside the Medicaid, Child Health Plan Plus (CHP+), and other health Safety Net programs administered through the Colorado Department of Health Care Policy & Financing. Solutions to achieve this objective may present in the form of utilization review, population management, case or disease management, value based and related alternate payment methodologies, digital tools that facilitate efficient provider selection or member insights, analysis supporting interpretations, insights, and solutions and more. The Office will also lead collaborative efforts to drive down healthcare costs and prices paid by consumers, employers and other payers, across the state. The Office will work collaboratively with other areas of the Department such as the Accountable Care Collaborative staff to secure insights into cost trend drivers and evolving utilization patterns. The Office will craft cost management strategy, select cost management vendor partners, oversee cost management program effectiveness and return on investment within the Medicaid, CHP+ and other health Safety Net programs.

Description of Job
Position serves as a clinical quality resource to the Clinical Operations Division within the CCQI Office and for the entire Department. Position will provide expertise not otherwise available at the Department and serves in a role that leverages clinical and quality related experience to triage quality and metrics related issues or questions that arise. This position will offer expertise regarding quality concerns, medical policy, and coding such as the Healthcare Common Procedure Coding System (HCPCS) or other standardized code sets applicable to the Department. This position will also be required to navigate provider billing issues, payment reform, and assist with the implementation of clinical assessment tools. This position will determine national performance metrics included in programs such as Healthcare Effectiveness Data and Information Set (HEDIS), hospital quality improvement programs (HQIP), other hospital transformation programs, and Electronic Health Records (EHR) based measures such as Electronic Clinical Quality Measures(eCQMs) or registry reporting.

The Clinical Quality Nurse will support the Chief Medical Officer with specialty programs including the development and implementation of maternity, preventive, and chronic disease programs. This position will offer expertise regarding current practices concerning clinical programs and benefits. This position will work closely with the CMO, CNO, Clinical Research Analyst, Performance and Quality Metric Analyst, external stakeholders, and other Department staff associated with the Clinical Evidence Advisory Committee (CEAC).

Position will consult on internal committees and groups such as, but not limited to, the Hospital Transformation Program (HTP), the Alternative Payment Model (APM), and other internal workgroups or external committees reviewing Department performance or quality metrics. Position will lead the creation, implementation, and oversight of an internal Quality Improvement Cross-matrix Workgroup. This position may also be required to represent the CNO on external stakeholder committees as requested and manage or advise on contracts including contracts associated with the CEAC, our External Quality Review Organization (EQRO), Pediatric Consulting contract, or others as determined by CCQI Leadership.

Minimum Qualifications, Substitutions, Conditions of Employment & Appeal Rights


Education and Experience:
Bachelor's degree from an accredited institution in a field of study related to the work assignment. Current, valid licensure as a Registered Nurse from the Colorado Board of Nursing or any state participating in the Enhanced Nurse Licensure Compact (eNLC). Five (5) years of professional experience in an occupational field related to the work assigned to the position.

Additional appropriate experience will substitute for the degree requirement on a
year-for-year basis.

- Clinical experience in a diversity of settings and with a diverse population of clients.
- Experience implementing and overseeing program compliance and quality improvement.
- Knowledge of how to gather and analyze quality related data and produce report of findings.
- Experience with program development involving complex problem resolution.
- Master's Degree

Highly Desired:
- Current knowledge of Medicaid and the health care industry, statutes, and regulations.
- Health care project management experience.
- Experience researching, analyzing, developing, and implementing health care policy.
- Experience with data analysis, policy analysis, and program evaluation to develop solutions to problems, make recommendations to leadership, and implement policy, process, and programmatic improvements.
- Experience drafting formal reports for internal and external distribution and publication.

DEFINITION OF PROFESSIONAL EXPERIENCE: Work that involves exercising discretion, analytical skill, judgment, and personal accountability, and responsibility for creating, developing, integrating, applying, and sharing an organized body of knowledge that characteristically is uniquely acquired through an intense education or training regimen at a recognized college or university; equivalent to the curriculum requirements for a bachelor's or higher degree with major study in or pertinent to the specialized field; and continuously studied to explore, extend, and use additional discoveries, interpretations, and application and to improve data, materials, equipment, applications and methods.

Conditions of Employment

- All positions at HCPF are security sensitive positions and require individuals undergo a criminal record background check as a condition of employment.
- Statewide travel is a regular part of this position and may involve overnight and/or extended stays for conferences and meetings. Position must also regularly visit and collaborate with RAEs and variousstakeholders.
- Employees who have been disciplinarily terminated, resigned in lieu of disciplinary termination, or negotiated their termination from the State of Colorado must disclose this information on the application.

Appeal Rights
If you receive notice that you have been eliminated from consideration for the position, you may protest the action by filing an appeal with the State Personnel Board/State Personnel Director within 10 days from the date you receive notice of the elimination.

Also, if you wish to challenge the selection and comparative analysis process, you may file an appeal with the State Personnel Board/State Personnel Director within 10 days from the receipt of notice or knowledge of the action you are challenging.

Refer to Chapters 4 and 8 of the State Personnel Board Rules and Personnel Director's Administrative Procedures, 4 CCR 801, for more information about the appeals process. The State Personnel Board Rules and Personnel Director's Administrative Procedures are available

A standard appeal form is available If you appeal, your appeal must be submitted in writing on the official appeal form, signed by you or your representative, and received at the following address within 10 days of your receipt of notice or knowledge of the action: Colorado State Personnel Board/State Personnel Director, Attn: Appeals Processing, 1525 Sherman Street, 4th Floor, Denver, CO 80203. Fax:303-866-5038. Phone:303-866-3300. The ten-day deadline and these appeal procedures also apply to all charges of discrimination.

Supplemental Information

Applicants are encouraged to submit a resume and cover letter with their application. Please note that ONLY your State of Colorado job application will be reviewed during the initial screening; if you submit a resume and cover letter, they will be reviewed in later stages of the selection process. Therefore, it is paramount that you clearly describe all of your relevant experience on the application itself. Applications left blank or marked "SEE RESUME" will not be considered.

Your application will be reviewed against the minimum qualifications for the position. If your application demonstrates that you meet the minimum qualifications, you will be invited to the comparative analysis process, which is described below.

Comparative Analysis Process

The comparative analysis process wil

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