Denver Health

General

• Under general supervision, facilitate and coordinate the care delivered to an assigned group of patients through multidisciplinary and patient/family collaboration.
• Conduct assessments, planning, support, and evaluation of patient care and related outcomes.
• Facilitate appropriate status and level of care, screening for high risk and transition of care needs.
• Work with patient and family to identify goals and outcomes, developing evidence-based interventions and care plans.
• Implement care plans and conduct systematic and timely evaluation of outcomes of nursing care.
• Document care according to organizational standards, contractual and regulatory requirements.
• Advocate to secure benefits for patients and identify potential barriers to payer coverage.
• Coordinate community resources and provide care management to appropriate patients according to organizational policies and payer guidelines.

Registered Nurse Care Coordinator – Case Management

Call Center Representative

• Under close supervision, serves customers by answering incoming calls utilizing Denver Health and Departmental policies/processes to resolve customer requests and directing calls to the appropriate area when necessary.
• Responsible for effectively screening/identifying customer requirements and taking appropriate action based on this information.
• Provides assistance to Denver Health staff by collecting demographic, medical complaint and key information required to facilitate appropriate patient care and call resolution. Completes computerized patient scheduling, collection of comprehensive demographic and insurance information required to facilitate timely and accurate billing of services, obtainment of pre certification authorization and benefit information necessary for payment
• Answers all calls in a courteous, respectful and helpful manner utilizing interpretation services to facilitate customer communications; performs information lookups using all sources of data to provide rapid, accurate call resolution.
• Fulfills internal and external customer requests by clarifying desired information, utilizing Denver Health resources to complete transactions, forwarding requests when appropriate.
• Understands standardized scheduling, rescheduling, and cancellation guidelines. Schedules to appropriate provider according to patient request, provider direction, and availability according to preset approved scheduling guidelines.
• Maintains continuity of work operations by documenting and communicating actions, completes activity reports and communications upon request for various Departmental functions and initiatives; keeps equipment operational by following established procedures and reporting malfunctions.
• Determines requirements by working with customers; answers inquiries by clarifying desired information, researching, locating and providing information; taking action based on this information either to resolve the customer’s request or transfer appropriately.
• Resolves customer problems by clarifying issues; researching and exploring answers and alternative solutions; implementing solutions; escalating unresolved problems.
• Educates customers on additional services by recognizing opportunities to enhance the customers experience and meet their needs; informs and guides patients to resources.
• Proficient in gathering, verifying and updating demographic, financial, guarantor, insurance and patient information for new and existing patients within the practice management/electronic health record and various Denver Health computer applications.

Scheduler I, Call Center

Medical writer

• Under general supervision performs concurrent and retrospective reviews as requested by the Clinical Documentation Integrity Manager or Director.
• Responsible for selected assignments based on internal or external department requests.
• Responsible for educating providers regarding documentation specificity, accuracy, compliance and are permitted to query physicians as deemed necessary.
• Collaborates with Coding, Health Information Management (HIM), Patient Safety and Quality, Enterprise Compliance Services and other departments to promote the common goal of obtaining accurate documentation in the patient's record.
• Must participate in continuous education on ICD-10, clinical medicine, Center of Medicare and Medicaid (CMS) and other billing carriers, as well as coding guidelines and policies.

RN Specialist, Clinical Documentation

Pharmacist

• Fills and delivers/dispenses medications under the supervision of a licensed pharmacist.
• Performs introductory technical tasks in specialty areas such as medication histories, sterile and non-sterile preparation, payer adjudication, call center, clinical pharmacy support, inventory management including controlled substance handling and accountability, and repackaging.
• Uses appropriate systems for processing of patient information.
• Triages and escalates any questions or issues outside the pharmacy technician scope of practice to the staff pharmacist or supervisor as needed.
• Ensures adequate supplies are available for continuous patient care.
• Operates pharmacy equipment appropriately.

Pharmacy Technician II – Correctional Care

Learning and Development

• Support educational needs of front desk, scheduling, and registration staff.
• Design, develop, and deliver communication and education for users of Epic (the electronic health record (EHR) used at Denver Health).
• Create and maintain documentation, curriculums, and e-learnings (blended learning, synchronous and asynchronous learning).
• Monitor training program effectiveness, review and evaluate work, and offer performance reports.
• Documentation, materials creation and maintenance - Design, develop, track, evaluate, improve and maintain training curriculums, eLearning modules, curriculums and classes, materials such as job aids, bulletins, and huddle sheets, etc. based on workflow research and analysis, collaboration with stakeholders, and a thorough understanding of the Epic software.
• Analyze content, target audience, job tasks and learner environment to identify appropriate instructional strategies and modalities.
• Research system updates in vendor tools to identify education and change management opportunities and risks.
• Deliver content that meets the needs of a broad spectrum of adult learners.
• Work with SMEs, analysts and team members to ensure training deliverables are in line with both organization goals and the delivered solutions.
• Use Learning Management System (LMS) to deliver training and to track and report results.
• Regularly analyze work to identify opportunities to improve.
• Support the educational development of best practices.
• Communication, facilitation and presentation - Deliver content — Lead classes and labs, make formal and informal presentations to leadership, team members and end users.
• Learn curriculum, systems, and roles necessary to schedule, coordinate and deliver train-the-trainer classes, classroom training and virtual training to users in multiple roles across supported applications.
• Project Management - Manage timelines, resources, and milestones of assigned projects. Communicate training plans to project manager and stakeholders.
• Liaise, rounding, help tickets and At The Elbow (ATE) support - Act as a liaison with users taking time to understand their needs and developing relationships through interpersonal skills and effective, consistent communication.
• Work tracking and documentation - Use problem/request tracking tools to keep documentation current on all assigned tasks. Complete work status and time allocation documentation.
• Maintenance and improvements - Follow standards and expectations for annual review and update of all content: Job aids and tipsheets, curriculum, training environment build, content on LMS, etc. Using available data, analyze value of current offerings and identify opportunities to improve.
• Learning and uptraining - take classes, pass tests, shadow users and become a workflow expert for the Epic applications you are assigned to learn. Complete assigned and required proficiency for Epic assigned applications and certify in the application.

Instructional Designer I – Front Desk/Scheduling/Registration

• Performs supervisor/leadership functions over the Denver Health Medical Plan (DHMP) / Managed Care Pharmacy clinical pharmacist and administrative staff.
• Applies critical thinking, clinical knowledge, evidence-based policies, procedures, guidelines, and competence to collaborate with the team to promote excellence and quality outcomes.
• Provides operational and collaborative leadership for the Managed Care Pharmacy Department.
• Maximizes efficiency and positively impacts the care provided to members.
• Collaborates with different teams within the organization.
• Leads the development of specific departmental goals, standards, and objectives that directly support the strategic plan and vision of the organization.
• Promotes department sustainability and cost containment efforts to achieve budget.
• Identifies and implements strategies to monitor variance reports to enhance productivity while maintaining high-quality service.
• Implements programs that promote high motivation among team members by coaching, counseling, and setting goals for direct reports.
• Supervises Pharmacist Clinical Specialist and Pharmacy Technician Call Center staff.
• Sets and communicates expectations to each employee and establishes job requirements and performance appraisal components.
• Regularly provides individual assessments to ensure timely feedback on performance expectations.
• Performs timeliness monitoring, prior authorization, and call center auditing, and presents annual reports to the Medical Management Committee (MMC) and Quality Management Committee (QMC).

Pharmacy Supervisor

Manager

• Oversee the HEDIS/ HOS data collection, development and analysis
• Maintain and update appropriate data collection systems
• Support strategic goals of MCR Stars by providing subject matter expertise on quality metrics and HEDIS strategy
• Support NCQA accreditation process by providing subject matter expertise on quality standards
• Determine work procedures and expedites workflow; assigns duties and reviews work
• Prepares necessary and required reports to management
• Identifies problems and opportunities for improvement; identifies appropriate solution and involves others in the implementation process
• Prepares and/or reviews daily, weekly, monthly and quarterly quality assessment reports
• Conducts/reports findings for QI data for all lines of business as required for HEDIS/ HOS activities
• Partners with vendors and manages tracking progress during and prior to submission
• Creates annual HEDIS training and testing materials