Director - Clinical Programs

Job Description

Job DescriptionJoin Our Team as the Director of Clinical Programs!

Are you ready to make a significant impact in the world of healthcare? As the Director of Clinical Programs, you will play a pivotal role in shaping the future of population health and quality outcomes across our organization. Your leadership will guide the development and implementation of innovative clinical programs that focus on Medicare Stars, Medicaid performance measures, and other critical quality outcomes for our priority populations.

Your Mission:

In this dynamic role, you will:

• Collaborate with our analytics team to evaluate clinical outcomes and drive continuous quality improvement.
• Ensure that all programs are grounded in evidence-based practices and innovative member engagement strategies.
• Develop and execute procedures to meet performance standards for quality, timeliness, and compliance.
• Align strategic goals across clinical and operational areas, working closely with stakeholders to achieve core business objectives.

What We’re Looking For:

To thrive in this role, you should have:

• A Master’s degree and an active NM RN license.
• At least 5 years of relevant leadership experience.
• Experience in Managed Care Organizations (MCO) and clinical program development.
• Chronic disease management experience is preferred.

Your Responsibilities Will Include:

• Utilizing population analysis and outcomes data to identify opportunities for clinical program development.
• Creating new clinical programs aimed at achieving population health and quality goals, including MA Stars and Medicaid HEDIS measures.
• Engaging with key provider partners and clinical leaders to design evidence-based programming.
• Integrating behavioral health and social needs into clinical programming for holistic member care.
• Developing effective member engagement strategies based on feedback and best practices.
• Providing leadership support to ensure our Nurse Advice Line and Disease Management programs meet quality and compliance standards.
• Applying change management and continuous quality improvement principles to enhance existing programs.
• Collaborating with clinical and nonclinical teams to maximize resources and budget for clinical programs.

Why Choose Us?

At Presbyterian, we believe in more than just standard benefits. Here’s what you can expect:

• Access to a robust wellness program, including free on-site and community-based gym access, nutrition coaching, and wellness challenges.
• Opportunities for professional growth and development.
• A supportive and collaborative work environment where your contributions truly matter.

About Us:

Presbyterian Healthcare Services is dedicated to improving the health of our communities. Founded in New Mexico in 1908, we are the state's largest private employer, serving over 580,000 members through our health plan and multi-specialty medical group.

Discover New Mexico:

New Mexico is a place of stunning landscapes and rich culture, offering endless recreational opportunities. Whether you enjoy hiking, skiing, or simply soaking in the beauty of nature, you’ll find it all here.

Join us in our mission to enhance the health of New Mexicans and be part of a remarkable team that is making a difference every day!

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

Maximum Offer for this position is up to: USD $75.14/Hr.

Compensation Disclaimer: The compensation range for this role considers various factors, including experience, training, internal equity, and organizational needs.