Director - Clinical Programs

The Director of Clinical Programs leader is responsible for identifying, implementing, and overseeing new in-house and vendor-delivered clinical programs to achieve organizational population health and quality goals across the risk continuum and for all lines of business, with a focus on Medicare Stars, Medicaid performance measures, and other clinical quality outcomes for highly impactable priority populations across all health plan products. This leader is responsible for clinical and operational direction and oversight of daily operations for Presbyterian Health Plans existing disease management program and nurse advice line.

 

This leader will: 

• Work with our analytics team to evaluate clinical outcomes and apply continuous quality improvement principles to drive improvement.
• Ensure new and existing programs are delivered using current evidence-based practices and innovative member engagement approaches.
• Develop and execute procedures to ensure that performance standards for quality, timeliness, and compliance are achieved.
• Align strategic goals and objectives across PHP clinical and operational areas, in concert with relevant stakeholders, to ensure defined solutions meet core business objectives.

• Masters degree and active NM RN license required.
• 5 years of relevant leadership experience required.
• Managed Care Organization (MCO) and clinical program develop experience required.
• Chronic disease experience preferred.

• Uses population analysis and outcomes data to identify areas of opportunity for clinical program development.
• Develops new clinical programs to achieve population health and quality goals, including MA Stars and Medicaid HEDIS measures and reduction in health disparities evident in New Mexico communities.
• Seeks input from key provider partners and clinical leaders to design evidence-based programming and engage providers in partnering with PHP to achieve clinical outcomes.
• Integrates behavioral health and social needs into clinical programming to ensure members wholistic needs are met.
• Develops effective approaches to engaging members in clinical programming using members, staff, and community feedback, as well as national best practice.
• Provides leadership support to Nurse Advice Line and Disease Management leadership to ensure programs are meeting quality, timeliness, and compliance requirements and delivering the best care possible to PHP Members.
• Uses change management and continuous quality improvement principles to maximize clinical outcomes achieved by existing programs.
• Assists team with creation of policies, procedures, regulatory reporting, and staff training.
• Identifies and executes opportunities to collaborate with clinical and nonclinical teams throughout PHP, including care coordination, performance improvement, medical directors, and pharmacy.
• Oversees resources and budget for clinical programs and demonstrates potential ROI for new and existing clinical programming.

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 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.

USD $75.14/Hr.

The compensation range for this role takes into account a wide range of factors, including but not limited to experience and training, internal equity, and other business and organizational needs.