VP - Medicaid

Presbyterian Health Plan (PHP) seeks to continue to be a national leader in serving the complex and diverse needs of Medicaid members and in working with State and Federal agencies on designing and implementing new and innovative programs and services to meet the unique needs of this population.

The Vice President of Medicaid reports to the President of PHP and is accountable for all aspects of our Medicaid program including as the sole Contractor for Children in State Custody. This leader provides strategic and thought leadership to include best practices, emerging practices and innovations on a national scale that are intentionally connected to a deep understanding and solutioning for the needs of New Mexicans across a diverse set of communities including rural, frontier, Native American sovereignties, and urban centers. The Medicaid program includes provisioning for all the physical, behavioral health, and long-term services and supports (LTSS) of Medicaid members, including dental, vision, pharmacy, etc., and the full spectrum of social determinants of health, to include transportation, and supporting health equity across and within our unique populations.

The position offers an exciting opportunity to lead and shape Medicaid programs that have a significant impact on the health and well-being of vulnerable populations. The ideal candidate will possess a combination of strategic vision, operational expertise, leadership skills and government relations experience to drive positive outcomes and advance Presbyterian's mission of ensuring all our members can achieve their best health.

• Bachelors degree in healthcare administration, public health, business administration or related field.
• Extensive experience (10+ years) in healthcare management, with focus on Medicaid programs.
• In-depth knowledge of full array of Medicaid programs, regulations, policies, best practices, and emerging innovations at Federal and State level.
• Extensive government relations experience is required, preferably within the New Mexico market.
• Strong leadership skills with proven track record of driving organizational change and achieving results through influencing and collaboration.
• Excellent communication, negotiation, and relationship-building skills.
• Strategic thinker, ability to analyze complex issues, and develop innovative solutions.
• Demonstrated ability to collaborate effectively with diverse stakeholders and manage cross-functional teams.
• Experience in budgeting, financial management, and performance measurement.
• Commitment to equity, diversity, and inclusion
• Must live in the New Mexico area.

• Developing and executing strategic plans that meet the needs and expectations of Medicaid members, relevant State of New Mexico agencies including the Healthcare Authority (HCA) and Children, Youth and Families Department (CYFD), CMS and key stakeholders.
• Forming, collaborating with and leading diverse teams across PHP, to ensure effective delivery of Medicaid services while maintaining compliance with regulations and achieving organizational strategies, goals and metrics, as well as the strategies, goals and metrics of HCA and CYFD.
• Providing ongoing surveillance of national and state market changes and developments to ensure that PHP remains competitive and viable in the future.
• Leading the design, development and enhancement of Medicaid programs to meet the evolving needs of beneficiaries and stakeholders, to include for example, evidence-based models applicable to unique populations such as those specific to Children in State Custody and Behavioral Health.
• Provide thought leadership and input on the State's strategy for achieving their vision and objectives and fostering alignment with Presbyterians capabilities and new business models, to include for example improving access to behavioral health and substance use disorder services and supports and expanding availability of models and services to serve Children in State Custody.
• Overseeing day to day operations for Medicaid programs working in collaboration with executive leaders and operational leaders.
• Leading functional teams to serve our Medicaid members and meet and exceed the needs and expectations of stakeholders without direct reporting relationships, to include for example, network contracting and development, claims, population health inclusive of pharmacy, etc.
• Aligning Medicaid to the Dual Special Needs Plan (D-SNP) requirements to support optimal performance and outcomes.
• Proactively monitoring changes in Medicaid waivers, state plan amendments, policy and legislation to mitigate risks, inform strategies, and maintain program integrity.
• Engaging fully in the government relations process to influence a positive perception of PHP's Medicaid program.
• Provide strategic direction and alignment with key stakeholders over quality initiatives to improve the quality, efficiency and effectiveness of Medicaid services, including performance measures, outcome evaluation, and continuous process improvement.
• Establishing and overseeing strategic workstreams and deliverables, scorecard metrics including quality, experience, and financial measures, to measure achievement of effective outcomes while maximizing value for members and stakeholders.
• Build and maintain relationships with key stakeholders, including government agencies, healthcare providers, advocacy groups, community organizations, and policymakers.
• Develop and lead high performing teams, providing leadership, guidance and mentorship over a high-functioning team fostering a culture of accountability, innovation, and excellence.
• Leads all Medicaid procurement activities including ongoing market and technology assessments, preparation efforts and resource planning, market positioning, consultant sourcing, marketing and branding, and the response development cycle

We offer more than the standard benefits!

Presbyterian employees gain access to a robust wellness program, including free access to our on-site and community-based gyms, nutrition coaching and classes, wellness challenges and more!

Learn more about our employee benefits:

https://www.phs.org/careers/why-work-with-us/benefits

Why work at Presbyterian?

As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans. For our employees, we offer a robust wellness program, including free access to our on-site and community-based gyms, nutrition coaching and classes, wellness challenges and more.

Presbyterian's story is really the story of the remarkable people who choose to work here. The hard work of our physicians, nurses, employees, board members and volunteers grew Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system that serves more than 875,000 New Mexicans.

About Presbyterian Healthcare Services

Presbyterian Healthcare Services exists to improve the health of patients, members and the communities we serve. We are a locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1,600 providers and nearly 4,700 nurses.

Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

About Our Regional Delivery System

Presbyterian's Regional Delivery System is a network of six hospitals and medical centers throughout rural New Mexico including locations in Clovis, Espanola, Ruidoso, Santa Fe, Socorro and Tucumcari. Our regional facilities are home to more than 1,600 clinical and non-clinical employees who help make Presbyterian the state's largest private employer with nearly 14,000 statewide employees. With a variety of services ranging from general surgery to pediatrics to heart and cancer care, our regional employees are proud to provide close-to-home care for their communities.

We are part of New Mexico's history - and committed to its future. That is why we will continue to work just as hard and care just as deeply to serve New Mexico for years to come.

About New Mexico

New Mexico continues to grow steadily in population and features a low cost-of living.

Varied landscapes bring filmmakers here from around the world to capture a slice of the natural beauty New Mexicans enjoy every day. Our landscapes are as diverse as our culture - from mountains, forests, canyons, and lakes, to caverns, hot springs and sand dunes.

New Mexico offers endless recreational opportunities to explore and enjoy an active lifestyle. Venture off the beaten path, challenge your body in the elements, or open yourself up to the expansive sky. From hiking, golfing and biking to skiing, snowboarding and boating, it's all available among our beautiful wonders of the west.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.