Director Clinical and Quality Programs

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 states largest private employer with nearly 14000 employees - including more than 1600 providers and nearly 4700 nurses.

This experienced nurse leader plays a pivotal role in driving clinical excellence quality improvement and regulatory compliance across Presbyterian Health Plan (PHP). As a strategic healthcare executive this role provides comprehensive oversight of PHPs quality programs clinical initiatives and regulatory operations ensuring alignment with national standards and organizational goals.

Key Responsibilities:

• Lead and manage clinical program development including innovative in-house and vendor-delivered solutions to improve population health outcomes across all lines of business.
• Oversee performance in Medicare Stars Medicaid quality measures and other high-impact clinical metrics for priority populations.
• Direct daily operations of PHPs disease management program and nurse advice line ensuring evidence-based care and member engagement.
• Guide PHPs NCQA Accreditation Regulatory Quality Clinical Care Quality and Critical Incident teams to maintain compliance with CMS HCA OSI and NCQA standards.
• Collaborate with analytics teams to evaluate clinical outcomes and apply continuous quality improvement (CQI) methodologies.
• Develop and implement strategic quality initiatives that enhance patient safety clinical effectiveness and health plan performance.
• Align clinical and operational strategies across departments to meet core business objectives and improve member experience.

Strategic Impact:

• Champion evidence-based practices and innovative care models to improve health outcomes.
• Ensure timely and compliant delivery of clinical programs using modern engagement techniques.
• Drive performance standards in quality timeliness and regulatory compliance.
• Foster cross-functional collaboration to support PHPs mission of delivering high-quality cost-effective care.

• Masters degree and active NM RN license required.
• 5 years of relevant leadership experience required.
• MCO and clinical program develop experience required.
• Chronic disease experience preferred.
• CPHQ certification required within 18 months of hire.

• Designs and implements evidence-based clinical programs to improve population health outcomes including Medicare Stars Medicaid HEDIS measures and reduction of health disparities in New Mexico.
• Uses data analysis provider input and community feedback to identify opportunities develop programming and engage members through innovative and effective strategies.
• Integrates behavioral health and social determinants of health into clinical initiatives to address members holistic needs and improve care coordination.
• Provides strategic and operational leadership for the Nurse Advice Line Disease Management and Quality teams ensuring compliance timeliness and high-quality care delivery.
• Leads health plan accreditation efforts and regulatory compliance activities including audits and reporting for CMS HCA OSI and NCQA while developing clinical guidelines and quality improvement strategies.
• Oversees staffing budgeting and ROI evaluation for clinical programs while fostering collaboration across departments and directing internal quality committees and initiatives.

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:

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.

Presbyterians 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 875000 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 its 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.