Colorado Access
Regency Plaza, 4643 S Ulster Street, Suite 700, Denver, Colorado, United States of America
Job Description Posted Tuesday, January 13, 2026 at 9:00 AM
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.
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 DIRECTOR OF MEDICAL REVIEW who can help shape our vision and support our mission. Here is what the position will look like.
Senior Director Responsibilities:
Provides strategic direction and oversees the management and maintenance of multiple department deliverables striving for operational excellence (productivity, quality, SLAs, customer experience of services provided, etc.). Builds high performing teams with vision, leadership, goals and metrics. Serves as a role model for team members; takes action and inspires team members to embrace and implement culture initiatives. Provides awareness to department leaders and staff how their work impacts other departments, programs and the enterprise. Encourages collaboration and holds team members accountable for achieving outstanding results.
Responsible for all management functions including hiring, training, planning and directing work, coaching and staff development, managing and evaluating performance, recognizing and rewarding employees, corrective action procedures and practices, addressing complaints and resolving problems. Develops and manages multiple department budgets.
Works closely with Directors across the organization to make tactical and operational decisions that advance company strategies and goals and collaborates to deliver on company-wide deliverables/requirements.
Oversees/leads projects and continuous improvement initiatives across multiple departments and/or cross-functional teams.
Oversees the development and implementation of multiple department policies and procedures to ensure compliance with federal, state, local and company policies, rules and regulations.
Job Specific Responsibilities:
Own the end-to-end vision, strategy, and execution for Utilization Management (UM) and Pharmacy across all lines of business, ensuring alignment with organizational mission, values, and strategic imperatives.
Direct, develop, and evaluate the UM program annually ensuring success through medical review and prior authorization, behavioral health management, clinical intake, and inpatient and outpatient review.
Directs and develops specialty programs to support and ensure success of the UM program, inclusive of innovative programs that emphasize and utilize hospital collaborative work relationships, and internal and external partnerships; ensures compliance and administration of utilization policies through cost effective management of UM operations.
Partner with leaders across the enterprise to design and evolve utilization management and pharmacy strategies that support competitive benefit design, affordability, and member and provider experience across all lines of business.
Provide clinical and financial oversight of pharmacy team, pharmacy benefits, and pharmacy benefit manager (PBM), including contract management and value-based care incentives.
Develops, secures approval and monitors and reports on area operating budget; forecasts spending levels, staffing requirements and resource needs for area.
Serve as the organization’s go-to resource on state, federal, and NCQA requirements, shaping UM/Pharmacy policies, keeping the organization ahead of regulatory changes, and leading audits (EPSDT, MHPAEA, SUD Residential Review, and other compliance reviews).
Analyzes and reports significant utilization trends, patterns, and impact to appropriate departmental and medical staff committees to inform strategic planning and performance management
Turn utilization and financial data into actionable insights that drive performance improvements, reduce unnecessary costs, and support quality outcomes.
Facilitates educational training for clinical staff on issues related to utilization management processes, compliance updates and emerging best practices.
Lead the development of market-competitive UM and pharmacy approaches—including prior authorization optimization, delegation, automation, and provider-friendly practices—by monitoring competitor benchmarks, regulatory expectations, and emerging best practices.
What you will bring: Education: Master’s degree in behavioral health field, nursing, health services administration, or other related health care field; or an equivalent combination of education and experience.
Experience: Ten years of healthcare experience required, with five years in a managed care environment with progressive management experience. Must have experience in effectively managing a diverse group of professionals with varying backgrounds. Experience with program development and implementation required. Experience working with the Medicaid population and in a managed care setting preferred. Must have some public speaking experience.
Knowledge, Skills, and Abilities: Demonstrated interpersonal, negotiation, and leadership skills. Effective oral and written communication skills Ability to work independently and set priorities and meet challenging goals. Excellent time management skills with the ability to multi-task required. Knowledge of managed care, case management, utilization management, and systems which are integrated with Medical Management. Must be able to direct staff in a manner that promotes team building and communication. Must have excellent written and verbal communication and presentation skills. Must have working knowledge of word processing and spreadsheet programs, preferably in Microsoft Office. Knowledge of care coordination/utilization management software preferred. Knowledge of ICD-10, CPT4, HCPC coding required.
Licenses/Certifications: Clinical Licensure in field of study is required (e.g., RN, LPN, LPC, LCSW, LMFT, LAC). 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
$194,200.00 - $223,300.00
annually. Colorado Access has provided a compensation range that represents its good faith estimate of what Colorado Access may pay for the position at the time of posting. Colorado Access may ultimately pay more or less than the posted compensation range. The salary offered to the selected candidate will be determined based on factors such as the qualifications of the selected candidate, departmental budget availability, internal salary equity considerations, and available market information, but not based on a candidate’s sex or any other protected status.
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&DD (employee, spouse and dependent).
Short-term and long-term disability coverage.
Voluntary life insurance (employee, spouse, dependent).
Paid time off
Tuition reimbursement (based on eligibility).
Annual bonus program (based on eligibility, requirements and performance).
Where you will work: This position will be a hybrid model work environment, a blend of ‘In-Office’ and ‘Remote.’
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.
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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Job Description Posted Tuesday, January 13, 2026 at 9:00 AM
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.
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 DIRECTOR OF MEDICAL REVIEW who can help shape our vision and support our mission. Here is what the position will look like.
Senior Director Responsibilities:
Provides strategic direction and oversees the management and maintenance of multiple department deliverables striving for operational excellence (productivity, quality, SLAs, customer experience of services provided, etc.). Builds high performing teams with vision, leadership, goals and metrics. Serves as a role model for team members; takes action and inspires team members to embrace and implement culture initiatives. Provides awareness to department leaders and staff how their work impacts other departments, programs and the enterprise. Encourages collaboration and holds team members accountable for achieving outstanding results.
Responsible for all management functions including hiring, training, planning and directing work, coaching and staff development, managing and evaluating performance, recognizing and rewarding employees, corrective action procedures and practices, addressing complaints and resolving problems. Develops and manages multiple department budgets.
Works closely with Directors across the organization to make tactical and operational decisions that advance company strategies and goals and collaborates to deliver on company-wide deliverables/requirements.
Oversees/leads projects and continuous improvement initiatives across multiple departments and/or cross-functional teams.
Oversees the development and implementation of multiple department policies and procedures to ensure compliance with federal, state, local and company policies, rules and regulations.
Job Specific Responsibilities:
Own the end-to-end vision, strategy, and execution for Utilization Management (UM) and Pharmacy across all lines of business, ensuring alignment with organizational mission, values, and strategic imperatives.
Direct, develop, and evaluate the UM program annually ensuring success through medical review and prior authorization, behavioral health management, clinical intake, and inpatient and outpatient review.
Directs and develops specialty programs to support and ensure success of the UM program, inclusive of innovative programs that emphasize and utilize hospital collaborative work relationships, and internal and external partnerships; ensures compliance and administration of utilization policies through cost effective management of UM operations.
Partner with leaders across the enterprise to design and evolve utilization management and pharmacy strategies that support competitive benefit design, affordability, and member and provider experience across all lines of business.
Provide clinical and financial oversight of pharmacy team, pharmacy benefits, and pharmacy benefit manager (PBM), including contract management and value-based care incentives.
Develops, secures approval and monitors and reports on area operating budget; forecasts spending levels, staffing requirements and resource needs for area.
Serve as the organization’s go-to resource on state, federal, and NCQA requirements, shaping UM/Pharmacy policies, keeping the organization ahead of regulatory changes, and leading audits (EPSDT, MHPAEA, SUD Residential Review, and other compliance reviews).
Analyzes and reports significant utilization trends, patterns, and impact to appropriate departmental and medical staff committees to inform strategic planning and performance management
Turn utilization and financial data into actionable insights that drive performance improvements, reduce unnecessary costs, and support quality outcomes.
Facilitates educational training for clinical staff on issues related to utilization management processes, compliance updates and emerging best practices.
Lead the development of market-competitive UM and pharmacy approaches—including prior authorization optimization, delegation, automation, and provider-friendly practices—by monitoring competitor benchmarks, regulatory expectations, and emerging best practices.
What you will bring: Education: Master’s degree in behavioral health field, nursing, health services administration, or other related health care field; or an equivalent combination of education and experience.
Experience: Ten years of healthcare experience required, with five years in a managed care environment with progressive management experience. Must have experience in effectively managing a diverse group of professionals with varying backgrounds. Experience with program development and implementation required. Experience working with the Medicaid population and in a managed care setting preferred. Must have some public speaking experience.
Knowledge, Skills, and Abilities: Demonstrated interpersonal, negotiation, and leadership skills. Effective oral and written communication skills Ability to work independently and set priorities and meet challenging goals. Excellent time management skills with the ability to multi-task required. Knowledge of managed care, case management, utilization management, and systems which are integrated with Medical Management. Must be able to direct staff in a manner that promotes team building and communication. Must have excellent written and verbal communication and presentation skills. Must have working knowledge of word processing and spreadsheet programs, preferably in Microsoft Office. Knowledge of care coordination/utilization management software preferred. Knowledge of ICD-10, CPT4, HCPC coding required.
Licenses/Certifications: Clinical Licensure in field of study is required (e.g., RN, LPN, LPC, LCSW, LMFT, LAC). 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
$194,200.00 - $223,300.00
annually. Colorado Access has provided a compensation range that represents its good faith estimate of what Colorado Access may pay for the position at the time of posting. Colorado Access may ultimately pay more or less than the posted compensation range. The salary offered to the selected candidate will be determined based on factors such as the qualifications of the selected candidate, departmental budget availability, internal salary equity considerations, and available market information, but not based on a candidate’s sex or any other protected status.
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&DD (employee, spouse and dependent).
Short-term and long-term disability coverage.
Voluntary life insurance (employee, spouse, dependent).
Paid time off
Tuition reimbursement (based on eligibility).
Annual bonus program (based on eligibility, requirements and performance).
Where you will work: This position will be a hybrid model work environment, a blend of ‘In-Office’ and ‘Remote.’
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.
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.
#J-18808-Ljbffr