The Director of Insurance Products (DIP) is a senior leader for the Denver Health Medical Plan (DHMP). This position has responsibility for the strategy, development, maintenance, growth, and retention for all of DHMP's managed care plans, including: Medicaid Choice, Medicare Advantage, CHP+, Large Group, and Individuals on/off Exchange. In this capacity, the DIP will serve as the primary link between DHMP, the State of Colorado, and the Center for Medicare & Medicaid Services ("CMS") to ensure DHMP complies with state and federal requirements for these products and programs. The DIP must maintain effective relationships with all Regulators. Also responsible for all required program and product policy forms and materials for health plan members, including the Summary of Benefits, Coverage, and Evidence of Coverage handbooks, and ensuring these materials are in compliance with all regulatory and certification requirements. The DIP will have leadership responsibility for all Product Line Managers and for developing and implementing marketing strategies for all products. Ensures all contract deadlines and regulatory requirements are met. Assists with program and product development, assessment and pursuing all opportunities to grow business, participate in contractual and rate negotiations, and manages contract administration. Prepares and assists with regulatory reviews and ensures compliance with and adherence to federal, state and HCPF regulations, policies, and operations procedures. Responsible for the day-to-day operational management and staff supervision of product line leaders.The DIP is responsible for the coordination of all Plan compliance associated with programs and products with the DHMP Compliance Officer in activities to meet the expectations of all federal and state agencies.
1. Directs strategy and Product Line Managers for all DHMP products and programs:* CMS and State bid processes including, but not limited to, contractual terms, benefits design, program / system implementation, business development, strategic planning, regulatory requirements, new opportunities, and other business needs as appropriate.* Rating and Quality Reporting for all products.* Develops new business and creates strategy to grow membership and revenue. In conjunctions with Product Line Managers, implement all new business and/or changes in existing products with all Managed Care departments such as Claims, Information Systems, Health Plan Services, Provider Relations and Medical Management.
2. Determines work procedures and expedites workflow; develops department policies and updates procedures; assigns duties and reviews work; prepares necessary and required reports to management. Ensures that all enrollment processes are in compliance with all regulatory entities, federal, state, and local government.
3. Reviews and provisions staff development, training, and orientations as prescribed by regulatory agencies and Denver Health's policies.
4. Maintains adequate dialogue with direct reports and employees and maintains staff meetings. Provides resources, tools, and training needed to be successful and maintain performance levels and goals.
5. Monitors, evaluates, appraises employee's activities and ensures all goals are met in accordance with regulatory and Denver Health's policies and procedures.
6. Works closely with DHMP Compliance Officer to ensure DHMP's lines of business meet or exceed regulatory requirements including, but not limited to, policies and procedures reporting.
7. Evaluates priorities, performance measures, and savings opportunities for the Medical Plan using LEAN techniques.
8. Other duties as assigned.
Knowledge, Skills and Abilities
1. Ability to identify root cause of issues and implement appropriate solutions utilizing the correct resources.
2. Demonstrates initiative, exercises good judgment, exhibits strong service orientation, and has the ability to achieve results through others.
3. Demonstrated ability to collaborate effectively across a complex environment and organization.
4. Has excellent interpersonal skills, can interact professionally with all levels of employees and communicates well in writing and verbally.
5. Ability to multitask, prioritize, delegate, create, and implement standardized processes and operational workflow.
6. Able to identify the need for new policies and procedures to meet product and program requirements, as well as write new policies and procedures, and review existing documentation.
Computers and Technology
1. Proficient in Microsoft Office Products (Excel, Word, Access, Outlook, Visio).
2. Experience using claims processing systems (QNXT) preferred.
Education & Experience
1. Bachelor's degree required.
2. Seven years of experience working in managed care, health plan administration, health insurance brokerage, managed care vendor, state or federal health related oversight, and/or healthcare related organization required.
3. Three years of supervisory and management experience required.
4. Must have demonstrated knowledge and experience in state and federal health care programs and related regulatory requirements as demonstrated by having some combination of Medicare, Medicaid, CHP+, Large Group or Exchange plans. Experience in all 5 lines of business is not required.
5. Experience in product / program management, sales, working with regulators, working with underwriting or actuarial services on rate setting, contract administration, and using Lean process improvement techniques preferred.
All job applicants for safety-sensitive positions must pass a pre-employment drug test, once a conditional offer of employment has been made.
Denver Health is an integrated, efficient, high-quality academic health care system that is considered a model for the nation. The Denver Health system includes the Rocky Mountain Regional Level I Trauma Center, a 525-bed acute care medical center, Denver's 911 emergency medical response system, 8 family health centers, 15 school-based health centers, the Rocky Mountain Poison and Drug Center, the Denver Public Health Department, an HMO, and The Denver Health Foundation.
As Colorado's primary safety net institution, Denver Health is a mission-driven organization that has provided more than $3.3 billion in care for the uninsured in the last ten years. Denver Health is a leader in performance and quality improvements and remains financially secure, in part, due to its nationally recognized implementation of lean principles in healthcare. Denver Health is a major resource to the community, serving approximately 185,000 individuals and 67,000 children a year.
Located just south of downtown Denver, Denver Health is just minutes away from many of the cultural and recreational activities Denver has to offer.
We strongly support diversity in the workforce and Denver Health is an equal opportunity employer (EOE).
"Denver Health is committed to provide equal treatment and equal employment opportunities to all applicants and employees. Denver Health is an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class."
Internal Number: 2735
About Denver Health
Take your career to the next level at Denver Health, where we offer a robust benefits package and endless opportunities for growth. Denver Health is a nationally-ranked, locally-trusted, premier healthcare institution located in the heart of Denver, Colorado.Twenty-five percent of all Denver residents, or approximately 150,000 individuals, receive their health care here. We are known as an integrated health care system that encompasses multidisciplinary academic specialties, a community health system, a level I adult trauma center, pediatric emergency and urgent care center home to Denver Public Health and many of the nation’s leaders in medicine.