Laboratory & Radiology Policy Advisor

State of Colorado; Denver (CO); Hybrid; USD 95,000 - 125,000; Full time

Benefits offered by this job

PERA retirement benefits

Medical, Dental, Vision insurance

Flexible work arrangements

Paid time off

Job summary

State of Colorado seeks a Laboratory and Radiology Policy Advisor within the Health Policy Office. The role oversees Lab, Imaging, and Radiology benefits, develops and implements policy based on evidence, and collaborates with stakeholders to address care efficiency and cost effectiveness.

The position emphasizes contract alignment, guidance on new programs, and liaison work with providers, associations, and public entities. A residency requirement applies for this posting.

Qualifications

• Two pathways: 6 years health care administration/public policy experience, or a Bachelor's plus 2 years experience
• Education counts for experience per policy: Associate=2, Bachelor=4, Master=6, Doctorate=7
• Residency required at time of application, Colorado residents only

Responsibilities

• Formulates and manages Laboratory, Imaging and Radiology benefit operations
• Researches and recommends policy based on guidelines and evidence
• Builds relationships with stakeholders to address policy challenges
• Ensures services are included in managed care contracts and known to Regional Accountable Entities
• Drafts Provider Bulletins and updates billing manuals
• Analyzes state and federal laws to identify needed program amendments

Skills

Policy analysis

Stakeholder engagement

Public health knowledge

Project management

Healthcare policy implementation

Education

Bachelor's degree in public health / health administration / public policy

Job description

State Of Colorado Residency Required At Time Of Application

Note: This announcement may be used to fill multiple openings.

Envision Yourself Working at HCPF

The State of Colorado strives to create a Colorado for All by building and maintaining workplaces that value and respect all Coloradans through a commitment to equal opportunity and hiring based on merit and fitness. The State is resolute in non-discriminatory practices in everything we do, including hiring, employment, and advancement opportunities.

Department Information

The Department of Health Care Policy & Financing (HCPF) oversees and operates Health First Colorado (Colorado's Medicaid Program), Child Health Plan Plus (CHP+), and other state public health programs for qualified Coloradans. Our mission is to improve health care equity, access and outcomes for the people we serve while saving Coloradans money on health care and driving value for Colorado.

We are looking for a Laboratory and Radiology Policy Advisor for the Policy & Benefits Delivery System Division of the Health Policy Office (HPO)! The Policy and Benefits Delivery System Division of HPO is responsible for the administration and performance of Medicaid acute care services and programs. The services and programs include both physical health and behavioral health. Staff within the Division are responsible for stakeholder relations, policy development and implementation, contract management and performance, program administration and overall Medicaid program performance. The Division plays an important role in working toward the Department of Health Care Policy and Financing’s mission to improve access to cost-effective, quality health care services for Coloradans.

We are committed to increasing the diversity of our staff and providing culturally responsive programs and services. Therefore, we encourage responses from people of diverse backgrounds and abilities.

Benefits

• PERA retirement benefits including PERA Defined Benefit Plan, PERA Defined Contribution Plan, plus 401K and 457 plans
• Medical, Dental, and Vision insurance coverage
• Automatic Short-Term and Optional Long-Term Disability Coverage
• Life and AD&D Insurance
• Flexible Spending Accounts (FSAs)
• Family Medical Leave Act (FMLA) job protection and State of Colorado Paid Family Medical Leave (PFML)
• 11 Paid Holidays Annually and Accrued Annual and Sick Leave
• Accrued Sick Leave for State of Colorado Temporary Employees
• Flexplace and Flextime work arrangements
• Variety of discounts on services and products available through the State of Colorado's Work-Life Employment Discount Program
• Free RTD EcoPass to all eligible State Employees
• Reduced college tuition through CSU Global
• Credit Union of Colorado Membership Eligibility
• Some positions may qualify for the Public Service Loan Forgiveness Program. For more information, go to https://www.colorado.gov/pacific/dhr/student-loan-forgiveness-programs. https://dhr.colorado.gov/dhr-resources/student-loan-forgiveness-programs

We are onboarding new employees using a hybrid approach. The Department supports flexible work arrangements. Depending on the business need and description of the position, we have options that range from hybrid to full-time in the office. Specific discussions about the schedule will be discussed during the offer stage.

Please note - equipment provisioning and certain onboarding tasks will take place in person, in our downtown Denver office, on the first day of employment.

Description of Job

What You’ll Be Doing as Laboratory and Radiology Policy Advisor:

• Formulates, plans, designs, develops, evaluates, and resolves problems for, and manages the day-to-day operations of the Laboratory, Imaging, and Radiology Services benefits. These benefits include but are not limited to: laboratory and genetic testing services, imaging, radiology and the related professional and technical components of the services.
• Researches and recommends best practices based on gathered input and existing evidence-based guidelines to manage, identify and address benefit or policy gaps, respond to provider inquiries about benefit limitations and policy, and assess current and future benefit policies to meet the Department’s expectations for efficient, cost-effective, quality care of clients.
• Develops productive working relationships and collaborates with stakeholder groups and individuals to constructively address disagreements and policy challenges that are critical to the success of the benefit.
• Works with other sections to ensure all services managed by this position are included in managed care contracts and known to the Regional Accountable Entities within the Accountable Care Collaborative.
• Provides recommendations to other benefit and/or programs managers on ways to define and implement services for new programs or populations, and/or helps align current programs with the coverage policies of the benefit areas managed by this position.
• Serves as a liaison between the Department’s various stakeholders, such as professional associations, providers, clients, advocates, sister state agencies, and lobbyists.
• Coordinates with other sections to identify and establish metrics and/or benchmarks to monitor policy changes, track and monitor utilization and expenditures, provide or participate in quality improvement reviews, assist with medical coding (diagnosis and procedural) policies, assess the impact of different payment methodologies on the benefit areas managed by this position, and identify ways to enforce policy changes through claims system edits or prior authorization request requirements/criteria.
• Identifies issues that require additional clarification, and drafts necessary Provider Bulletin articles and makes necessary updates and revisions to respective billing manuals.
• Researches and analyzes the pertinent State and Federal laws and regulations and the Colorado Medicaid State Plan to identify areas where the benefit areas managed by this position, State Plan, or Colorado Code of Regulations may need to be amended.

Residency Requirement

This posting is only open to residents of the State of Colorado at the time of submitting your application.

Class Code & Classification Description

H1R3XX Policy Advisor III

Minimum Qualifications

There are two ways to qualify for this position:

• Option 1
  • Experience Only: Six (6) total years of professional experience in health care administration, public policy, business, or a closely related field.
• Option 2
  • Education and Experience: Bachelor's degree from an accredited institution in public health, health administration, public policy, or a closely related field AND Two (2) total years of professional experience in health care administration, public health, public policy, or a closely related field.
  • Appropriate education will substitute for the required experience on a year-for-year basis. Relevant education will be calculated as the following:
  • An associates will count as two years of experience
  • A bachelors will count as four years of experience
  • A masters degree will count for six years of experience
  • A doctorate or juris doctorate degree will count for seven years of experience

Note: Per the Job Application Fairness Act, you may redact information that identifies your age, date of birth, or dates of attendance at or graduation from an educational institution on your transcripts.

Preferred Qualifications

• Previous relevant professional state experience
• Advanced degree from an accredited institution in health care administration, public policy, business, or a closely related field.
• Previous professional experience with:
  • Policy administration, interpretation, and implementation, particularly state/local government management of health care
  • Analyzing and interpreting datasets to identify trends and inform decision making
  • Written and spoken stakeholder communication, and public speaking

Skills To Support Success

• Ability to independently learn complex issues, be curious about a wide range of health and policy related topics, and apply knowledge
• Ability to communicate on sensitive and nuanced subjects in a respectful and person-centered manner
• Ability to identify root causes of systemic issues and think critically about opportunities for program and process improvement

Definition of Professional Experience

Work that involves exercising discretion, analytical skill, judgment, 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 that the individuals undergo a criminal record background check as a condition of employment.
• Employees who have been disciplinary 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

An applicant who has been removed from an employment list or removed from consideration during the selection process may request a review by the State Personnel Director.

As an applicant directly affected by the results of the selection or comparative analysis process, you may file a written appeal with the State Personnel Director.

Review of the completed, signed, and submitted appeal will be timely on the basis of written material submitted by you, using the official appeal form signed by you or your representative. This form must be completed and delivered to the State Personnel Board by email at [e-mail] within ten (10) calendar days from your receipt of notice or acknowledgment of the Department’s action.

For further information on the Board Rules, you can refer to 4 Colorado Code of Regulations (CCR) 801-1, State Personnel Board Rules and Personnel Director's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes, at spb.colorado.gov/board-rules.

ADAAA Accommodations

The State of Colorado believes that equity, diversity, and inclusion drive our success, and we encourage candidates from all identities, backgrounds, and abilities to apply. The State of Colorado is an equal opportunity employer committed to building inclusive, innovative work environments with employees who reflect our communities and enthusiastically serve them. Therefore, in all aspects of the employment process, we provide employment opportunities to all qualified applicants without regard to race, color, religion, sex, disability, age, sexual orientation, gender identity or expression, pregnancy, medical condition related to pregnancy, creed, ancestry, national origin, marital status, genetic information, or military status (with preference given to military veterans), or any other protected status in accordance with applicable law.

The Department of Health Care Policy & Financing is committed to the full inclusion of all qualified individuals. As part of this commitment, our agency will assist individuals who have a disability with any reasonable accommodation requests related to employment, including completing the application process, interviewing, completing any pre-employment testing, participating in the employee selection process, and/or to perform essential job functions where the requested accommodation does not impose an undue hardship. If you have a disability and require reasonable accommodation to ensure you have a positive experience applying or interviewing for this position, please direct your inquiries to our ADAAA Coordinator, Anupreet Kaur, at [e-mail].

The Department of Health Care Policy & Financing does not offer sponsored visas for employment purposes.

The State of Colorado offers permanent employees a variety of benefits including medical, dental, life and disability insurance, as well as a comprehensive leave program. Please click the following link for detailed information: www.colorado.gov/pacific/dhr/benefits

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