Quality Program Manager-Senior

Overview

Now hiring 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.

How you belong matters here.

We value our employees' differences and find strength in the diversity of our team and community.

At Presbyterian, it's not just what we do that matters. It's how we do it - and it starts with our incredible team. From Information Technology to Food Services and beyond, our non-clinical employees make a meaningful impact on the healthcare provided to our patients and members.

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.

Qualifications

• 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 1year 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

Responsibilities

• 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

Benefits

All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.

Wellness Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.

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.

About Presbyterian Healthcare Services Presbyterian exists to ensure the patients, members and communities we serve can achieve their best health. 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.

Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

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 $45.82/Hr.

Compensation Disclaimer

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.