Quality Program Manager-Senior

Presbyterian is seeking a Quality Programs Manager-Senior

Anticipates, develops and implements health management programs and initiatives. Achieves clinical and fiscal improvements for their identified programs. Meets regulatory requirements.

Why Join Us

• Full Time - Exempt: Yes
• Job is based Rev Hugh Cooper Admin Center
• Work hours: Days
• Benefits: We offer a wide range of benefits including medical, wellness program, vision, dental, paid time off, retirement and more for FT employees.

Ideal Candidate:

Bachelors degree in Business, Nursing, Healthcare, 3 years professional experience with 1 year quality experience or 3 years RN experience

• Bachelors degree in Business, Nursing, Healthcare, or related field, Masters preferred.
• 6 years of relevant experience in lieu of bachelors degree
• 3 years professional experience with 1 year quality experience or 3 years RN experience.
• Compliance with specifics to Healthcare accreditation and CMS
• Managed Care and awareness enterprise operations, functions & processes
• MS Office Visio

• Lead the development and in-depth analysis of comprehensive reports, strategic program plans, and milestone tracking to enhance performance metrics in assigned measures or programs.
• Utilizing quality tools, identifies, develops, builds, and initiates evidence-based programs for improving health outcomes for specifically delineated programs or populations
• Creates and updates work plans, tasks, timelines, and measurements.
• Select engaging and relevant article topics, craft high-caliber content, and conduct thorough reviews of articles tailored for providers and members. Ensure that all written materials meet the highest standards of quality, clarity, and accuracy.
• Works with identified stakeholders regarding compliance.
• Conduct thorough outcomes assessments to evaluate the effectiveness and impact of programs and interventions. Utilize qualitative and quantitative methods to gather data, analyze results, and generate actionable insights.
• Facilitates collaboration throughout the health plan and external organizations, to optimize the success of population health and quality management activities using input and resources from the appropriate business units.
• Manages relationships with vendors and collaborates with contracted network providers, various coalitions, community organizations, etc.
• Aligns with organization and/or department strategic plans to develop, monitor, and report program plans and milestones.
• Monitor and analyze shifts in the managed care and regulatory landscape, proactively identifying trends and challenges. Develop and implement innovative initiatives that respond effectively to these changes, ensuring that programs and interventions remain competitive and aligned with industry best practices
• Compiles and presents summaries of health management activities in a professional format to the appropriate internal or external entities.
• Identifies & resolves issues, escalates as necessary
• Performs other functions as required
  
  

About Presbyterian Healthcare Services
Presbyterian offers a comprehensive benefits package to eligible employees, including medical, dental, vision, disability coverage, life insurance, and optional voluntary benefits.

The Employee Wellness Rewards Program encourages staff to engage in health-enhancing activities - like challenges, webinars, and screenings - with opportunities to earn gift to earn gift cards and other incentives.

As a mission-driven organization, Presbyterian is deeply committed to improving community health across New Mexico through initiatives like growers' markets and local partnerships. Founded in 1908, Presbyterian is a locally owned, not-for-profit healthcare system with nine hospitals, a statewide health plan, and a growing multi-specialty medical group. With nearly 14,000 employees, it is the largest private employer in the state, serving over 580,000 health plan members through Medicare Advantage, Medicaid, and Commercial plans.

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

USD $45.82/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.