President - Health Plan

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 over 14,000 employees - including more than 1,200 providers and nearly 4,000 nurses.

Our health plan serves more than 600,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

The Plan President is a visionary and results-driven leader responsible for the strategic direction, operational excellence, and financial performance of Presbyterian Health Plan. This role oversees all facets of the health plan, ensuring exceptional member experiences, regulatory compliance, innovative growth strategies, and alignment with Presbyterian's enterprise integration goals. The President will lead a high-performing team, foster relationships with key stakeholders, and champion initiatives that deliver greater value to members, providers, and partners. The Plan has longstanding relationships in the state, partnerships with community groups and a model of care developed by listening to the needs of the communities served. This position is the primary executive liaison with the state's regulator of Medicaid program.

• BA/BS degree required, Master's preferred.
• Successful track record in health plan leadership to include P&L experience with commercial and government payer programs.
• 10+ years of relevant leadership experience in the managed care/health care field.
• Inspirational, intuitive leader with a focus on transparency to create trust and constructive collaboration.
• Strong working knowledge of Medicaid, Medicare and commercial products and a passion for creating a unique model of care that integrates the care.
• Ability to effectively represent organization and company in external venues with proven track record negotiating and maintaining State, community, and legislative relationships.
• Ability to understand set strategy/objectives, assign accountability and monitor meaningful action steps.
• Strong financial management and analytical skills.
• Exceptional organizational and project management skills
• Excellent communication and presentation skills.

         Strategic Leadership:

• Advance the ongoing planning and strategy of Presbyterian's integration as a key leader on the enterprise leadership team.
• Develop and implement the health plan's strategic vision, ensuring alignment and balance with enterprise's overall mission and goals.
• Identify and capitalize on emerging market opportunities to drive growth, improve member outcomes, lower costs for patients and member, and enhance competitive positioning.
• Foster a culture of innovation, accountability, and excellence across the organization.
• Responsible for the development and execution of the health plans long-range strategies for Medicare, Medicaid, and Commercial products.
  
  Operational Excellence:
• Oversee the efficient operation of the health plan, including claims, provider networks, care management, and member services.
• Establish and monitor key performance indicators (KPI's) to ensure operational effectiveness and optimal member experiences.
• Drive continuous process improvement, leveraging data analytics and technology.
  
  Financial Stewardship:
• Ensure the financial health of the plan through effective budgeting, cost management, and revenue optimization.
• Evaluate and manage risk, maintaining appropriate reserves and adhering to regulatory financial requirements.
• Collaborate with finance teams to develop long-term financial plans and forecasts.
  
  Network Development and Contracting:
• Ensures network engagement through operating committees and single point of contact solutions to meet contracted performance targets.
• Identify gaps in access to care and recruit key provider solutions to expand access where it matters most.
• Partner within and outside Presbyterian to accelerate and deliver on value-based care models for network providers.
  
  Regulatory and Compliance Oversight:
• Ensure full compliance with all federal, state, and local regulations governing health plans, including Medicare, Medicaid, and ACA requirements.
• Maintain strong relationships with regulatory agencies and ensure timely and accurate reporting.
• Proactively address compliance risks and implement corrective actions when necessary.
  
  Stakeholder Engagement:
• Build and maintain strong relationships with key stakeholders, including providers, regulators, members, and community partners.
• Serves as a primary representative of the health plan in public forums, industry events, and stakeholder meetings.
• Partner with the board of directors to provide updates on performance, strategy, and market dynamics.
  
  Talent and Team Leadership:
• Recruit, develop, and retain top talent, fostering a culture of collaboration and excellence.
• Provide mentorship and leadership to senior management, ensuring alignment with organizational goals.
• Champion diversity, equity, and inclusion across the organization.

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 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.