Quality Program Manager-Senior-CISC

Location Address:

Compensation Pay Range:

Summary:

Responsibilities:

CISC Quality Program Manager is responsible for overseeing the implementation and evaluation of program activities that address the unique health needs of children in state custody. This role ensures compliance with regulatory requirements, drives quality improvement initiatives, and monitors performance metrics to achieve optimal outcomes for this vulnerable population. Key responsibilities include health education planning, health improvement strategy development, data analysis, and reporting to executive leadership. The position requires strong leadership, analytical skills, and the ability to manage complex stakeholder relationships while advancing organizational goals and improving child welfare outcomes. Sets clinical outcome targets and monitors clinical improvements for their identified programs year over year. Oversee a multidisciplinary team of stakeholders set on meeting programs and regulatory requirements.

Some key responsibilities include
* Lead the development and implementation of in-depth analysis of comprehensive reports, strategic program plans, and milestone tracking to enhance performance metrics for children in state custody.
* Utilize quality improvement tools to identify gaps and develop evidence-based interventions aimed at improving health, behavioral, and social outcomes for this vulnerable population.
* Facilitate 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.
* Create and maintain detailed work plans, timelines, and measurable objectives specific to CISC initiatives.
* Manages strategy, inputs, and outputs from contributors to the health plans quality improvement process- including developing health education activities, quality improvement activities, and performance improvement plans when necessary.
* Serves as the managerial lead for CISC quality and population outcomes, providing direction, performance coaching, and accountability across internal teams and delegated partners.
* Establishes and socializes a CISC outcomes narrative that clearly demonstrates health improvement and value (e.g., HEDIS, child welfare measures, evidencebased service utilization, equity gaps closed) to executive leadership and external oversight bodies.

Compliance & Regulatory Alignment
* Ensure adherence to state, contractual, settlement, and remedial managed care requirements for children in custody.
* Collaborate with compliance and government programs teams to monitor policy changes and adjust program strategies accordingly.
* Manage, plan, collect, and screen timely CISC deliverables from delegated partners for CISC.
* Chairs monthly performance huddles and quarterly joint operations reviews with PHP and Magellan; escalates risks and drives decisioning for interventions.
* Publishes a quarterly "CISC Health Outcomes Report" and an executive outcomes narrative connecting interventions to measurable impact.
* Implements performance improvement plans (PIPs) with vendors/providers; ties incentives and remediation to outcome attainment.

Performance Monitoring & Reporting
* Develop, implement, and improve upone dashboards and scorecards to track key performance indicators (KPIs) such as utilization of evidence based services, HEDIS improvements, NON- HEDIS child welfare performance ares
* Conduct monthly and quarterly performance reviews, compiling data for reporting to the CISC Director and executive leadership, and for joint oversight of CISC.
* Monitor vendor and provider compliance with contractual obligations and quality standards specific to CISC programs.
* Leads the development of annual and multiyear KPIs and yearoveryear outcome gains.

Quality & Outcomes Assessment
* Perform comprehensive outcomes assessments using both qualitative and quantitative methods to evaluate program effectiveness.
* Analyze trends in health, behavioral, and social indicators for children in custody and recommend corrective actions or enhancements.
Stakeholder Engagement & Collaboration
* Facilitate collaboration with child welfare agencies, behavioral health providers, community organizations, and advocacy groups to ensure and support CISC Program Improvements
* Manage relationships with contracted network providers and vendors delivering specialized services for children in custody.
Communication & Education
* Select and develop relevant health educational content.
* Manage CISC communication materials with substantive improvements in
* Present program performance summaries and strategic updates to internal leadership and external oversight bodies.
Leadership
* Support CISC Director and Behavioral Health Executive Director with in lieu of, or substitute coverage
* Coordinates crossorganization performance goals and shared outcomes with PHP and Magellan, aligning strategies, timelines, and measures to ensure consistent execution and seamless member experience.
* Orchestrates interdepartmental integration (Population Health, CISC, Behavioral Health, Quality, Clinical Leadership, Utilization Management, Provider Network, Compliance, Appeals & Grievances, and Data/Analytics) to deliver measurable improvement in clinical, behavioral, and social outcomes.
* Codevelops joint program strategy roadmap with PHP BH/CISC Leadership to be implemented by Magellan to align goals, dependency management, and synchronized deliverables across organizations.

Additional Duties Specific to CISC
* Implement continuous quality improvement (CQI) cycles, especially related to member or program level improvements, including quality reviews at the membership level.
* Track and report on utilization of specialized services (e.g., psychiatric care, therapeutic foster care) and identify gaps in access
* 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
* 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.
* Aligns with organization and/or department strategic plans to develop, monitor, and report program plans and milestones.
* 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

Qualifications:

• Preferred Education:
• MPH (Master of Public Health) - Focus in Health Policy & Management, Epidemiology, or Maternal & Child Health
• MHA (Master of Health Administration) with experience in quality, compliance, and managed care, MSW (Master of Social Work) - Clinical or Administration track, with child welfare emphasis or MSN/MPH (Nursing + Public Health)
• Preferred Experience:
• 3 years of experience in health plan administration roles.
• Strong Education and Experience Alternatives:
• * MSW/MBA (Healthcare concentration) - if the role leans into analytics, operations, and executive-level performance management. Or;
• * Undergraduate Degree, And: Public Health, Social Work, Psychology, Nursing, Healthcare Administration, or Data Analytics, with managed care experience and 5 years of relatable work experience.
• Supplemental Certificates Preferred but Not Required:
• CPHQ (Certified Professional in Healthcare Quality) - gold standard for quality improvement tools and methodologies, Lean Six Sigma - Green Belt (minimum) / Black Belt (preferred) for CQI cycles, workflows, and reducing variation. HEDIS/NCQA- Any formal training or certificates (e.g., NCQA Quality Oversight or HEDIS compliance workshops). PMI-PMP or CAPM - if program planning, milestone tracking and complex stakeholder management are core deliverables. Data tools: Intermediate/Advanced Excel, Power BI/Tableau, and familiarity with SQL or SAS is a strong plus.

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 improve the health of patients, members, and the communities we serve. We are 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 1600 providers and nearly 4,700 nurses.

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.