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The Director of Claims and Encounters provides strategic leadership, fiscal accountability and operational excellence for the Presbyterian Health Plan (PHP) Claims Operations and Encounter Resolution teams. This leader is responsible for directing the operations of the Claims Department for Commercial/ASO, Medicare and Medicaid products, to ensure that all functions related to claims receipt, processing and payment are performed within the established quality and quantity standards. You will lead the encounters resolution team and be the leader responsible for encounters completeness and facilitating maximized Medicaid rate setting. This leadership role is...
This role will be a key member of the PDS pharmacy leadership team and serves as a trusted advisor to the Chief Pharmacy Officer (CPO) for the Specialty Pharmacy services. This role will be responsible to lead and own the enterprise-wide strategy development and execution for Specialty Pharmacy initiatives, drive operational excellence, ensure follow-through on key priorities, and foster cross functional collaboration at all levels of the organization. This role will bring demonstrated operations, business development & vendor management skills to be an effective execution leader.
Why work at Presbyterian?
As an organization, we are committed to improving...
This role is responsible for ensuring that the Transformation Office (TO) drives financial impact across the organization; for reviewing business cases and coaching Initiative Owners and Workstream Leads (WSLs) as needed to improve business cases; for highlighting financial trends that could hinder or accelerate financial impact; and for communicating the financial impact to key stakeholders.
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...
Presbyterian Healthcare Services is seeking a Transformation Office Director. In this role you will demonstrate disciplined delivery and drive the program process; You will represent the VP Transformation at a program/workstream level and ensure that real impact of the transformation is captured and communicated; You will also own the performance management systems to include WAVE, team management & action lists.
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...
Presbyterian Healthcare Services (PHS) is seeking an experienced and strategic IT Procurement Director to lead technology sourcing and vendor management across both the Health Plan and Delivery System. This enterprise-level role will drive value, mitigate risk, and ensure technology procurement aligns with PHS's mission, business goals, and digital transformation priorities.
The Director will manage sourcing and contracting for IT hardware, software, telecom, cybersecurity, digital health platforms, cloud services, and professional services. The role will collaborate closely with IT, Cybersecurity, Finance, Compliance, and Legal teams, and serve as a key liaison to the CIO and CISO...
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...
The Director of Practice Administration is responsible and accountable for all administrative aspects, customer service and financial performance of the clinic. You will lead strategic, tactical and CQI planning, overseeing implementation and ongoing measure of same. This leader directs clerical oversight and collaborates with Administrative Director of the clinics to ensure sites provide high quality, cost-effective care. You will also serve as a support and liaison to providers.
Socorro, New Mexico, feels like the perfect place to relocate—quiet, scenic, and full of character. Tucked between rugged mountains and desert skies, it offers stunning views, a slower...
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.
Oversees compliance across an integrated delivery system, including both health plan and care delivery operations. Designs, implements, and manages a comprehensive Enterprise-Wide Compliance & Privacy Program aligned with federal guidance from the OIG, OCR, and industry standards. Partners with senior...
The Director of Strategic Sourcing for the Health Plan will lead sourcing strategy, supplier management, contracting, and cost optimization initiatives for all categories of spend supporting Presbyterian Health Plan. This includes categories such as third-party administrative services, pharmacy benefit management (PBM), behavioral health, IT and digital, care coordination, population health programs, marketing, consulting, and other non-clinical categories.
This individual will work closely with internal business owners, finance, legal, compliance, and vendor partners to ensure value-driven, performance-oriented sourcing decisions that align with the strategic and...
