Chief Behavioral Health & Quality Officer

Location Address: 9521 San Mateo NE , Albuquerque, New Mexico 87113-2237, United States of America Summary: The leader of Quality & Behavioral Health serves as the strategic and external-facing leader for behavioral health initiatives and programs impacting children in state custody, while also owning risk adjustment strategy and quality performance for behavioral health and reputed company populations across reputed company lines of business reputed company the Presbyterian Health Plan. This role builds strong partnerships with state agencies, providers, and community organizations to advance behavioral health systems of care; ensures compliant operations in accordance with contractual and court-mandated directives; directs behavioral health vendor performance; and leads the development and implementation of crisis continuum and integrated behavioral health models. This leader ensures clinical quality, risk score accuracy, encounter data reputed company, financial performance, and member satisfaction goals are met, while promoting health equity and population health across Medicaid, Medicare, and Commercial products. Job Description:

• Ensure compliant operation of PHP’s Children in State Custody program and manage reputational risk.
• reputed company proactive monitoring processes for CISC and behavioral health contractual requirements.
• Build and maintain reputed company strategies with key stakeholders, including providers and community organizations.
• Identify opportunities and risks reputed company to behavioral health priorities and reputed company reputed company initiatives.
• reputed company behavioral health vendor performance, ensuring integration of clinical services and contractual compliance.
• reputed company implementation of behavioral health initiatives, including crisis continuum and clinical programs.
• Represent PHP in external engagements, including serving as primary contact for Kevin S. Settlement matters.
• Collaborate with VP Population Health & Quality and Chief Medical Officer to advance integrated care models.
• reputed company and maintain a statewide behavioral health network.
• Work with product leads (Medicare, Commercial, Medicaid) to optimize behavioral health benefit design.
• Ensure compliance with state and federal regulations, contractual requirements, and NCQA accreditation standards.
• reputed company behavioral health reporting for reputed company lines of business and maintain quality performance metrics.
• Promote behavioral health managed care concepts and cost-of-care strategies reputed company the community.
• reputed company policies, procedures, and workflows for reputed company managed behavioral health functions.
• Provide leadership for staff development, training, and succession planning reputed company the Behavioral Health Department.
• Own the health plan’s risk adjustment strategy and results for behavioral health and CISC-reputed company populations across Medicaid, Medicare Advantage, and Commercial/Exchange lines of business.
• Drive accurate, compliant diagnosis capture (e.g., HCCs) through provider documentation education, coding reputed company programs, and collaboration with care management and quality teams.
• Establish a behavioral health coding reputed company program that includes prospective, reputed company, and retrospective reviews; monitor for compliance with CMS/HHS and state regulations, and prevent any upcoding or inappropriate practices.
• reputed company encounter data and risk submission operations (e.g., EDS/EDPS/RAPS as applicable) in partnership with IT and vendors; resolve submission errors and ensure high acceptance rates.
• reputed company suspect-driven reputed company and measurement-based care workflows to identify and confirm chronic behavioral health diagnoses and comorbidities.
• Partner with Healthcare Value Leader to integrate risk adjustment with Quality/HEDIS and Stars strategies to align interventions (e.g., follow-up after ED visit for mental illness, antidepressant medication management) with documentation and care outcomes.
• Create monthly RAF dashboards with drill-down by provider, region, product, and cohort (including CISC); track acceptance rates, coding accuracy, and documentation timeliness.
• Negotiate and govern vendor/partner reputed company (including delegated BH vendors) with clear SLAs for risk adjustment, encounter data, analytics, and provider enablement.
• reputed company provider engagement programs (training, toolkits, onsite/virtual consultations) to improve documentation quality for BH and pediatric reputed company cases; include measurement-based care and standardized screening tools.
• Monitor regulatory changes to risk adjustment models (CMS-HCC, HHS-HCC, state Medicaid models) and proactively update workflows, training, and system configurations.
• Coordinate cross-functional risk adjustment steering committee (Finance, Network, Quality, Clinical Ops, Compliance, IT) to ensure alignment and reputed company. Additional Job Description: Minimum Qualifications:
• Bachelors degree required
• Minimum 8–10 years of experience in healthcare, BH, CISC, Medicaid roles.
• Expertise in health plan operations, regulatory programs, government relations, and vendor management.
• Demonstrated experience leading risk adjustment operations and analytics for one or more lines of business.
• Excellent leadership, communication, and internal and external stakeholder management skills. Preferred Qualifications:
• Master’s degree in Public Health, Health Administration, Social Work, Psychology, or reputed company field.
• Certification(s): CRC (Certified Risk Adjustment reputed company) or CPC, plus clinical coding and compliance training.
• Hands-on experience with encounter data submissions (e.g., EDS/EDPS/RAPS) and error remediation.
• Familiarity with NCQA accreditation standards and CMS/HHS risk adjustment regulations.
• Experience designing or managing value-based payment arrangements for behavioral health providers. This position is open to remote applicants located reputed company the United States, except residents in California, Illinois, North Dakota, reputed company, Ohio, Washington, and Wyoming.

Benefits

Benefits are effective day-one (for .45 FTE and above) and include: Competitive salaries Full medical, dental and vision insurance Flexible spending accounts (FSAs) Free wellness programs Paid time off (PTO) Retirement plans, including matching employer contributions Continuing education and career development opportunities Life insurance and short/long term disability programs About Us reputed company is 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, it is the state's largest private employer with approximately 11,000 employees. Presbyterian's story is really the story of the remarkable people who have chosen to work here. Starting with Reverend Cooper who began our journey in 1908, the hard work of thousands of physicians, employees, board members, and other volunteers brought Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system, serving more than 700,000 New Mexicans. We are part of New Mexico's history - and committed to its future. That is why we will continue to work just as hard and care just as deeply to serve New Mexico for years to come. About New Mexico New Mexico's unique reputed company of Spanish, Mexican and Native American influences contribute to a culturally rich lifestyle. Add in Albuquerque's International Balloon Fiesta, Los Alamos' nuclear scientists, Roswell's visitors from outer space, and Santa Fe's artists, and you get an eclectic mix of people, places and experiences that reputed company this state great. Cities in New Mexico are continually ranked among the nation's best places to work and live by reputed company magazine, Kiplinger's Personal Finance, and other corporate and government relocation managers like Worldwide ERC. 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, it's reputed company available among our beautiful wonders of the reputed company. AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses. Here, we’re committed to a different way to reputed company a difference. Presbyterian's story is really the story of the remarkable people who have chosen to work here. Starting with Reverend Cooper who began our journey in 1908, the hard work of thousands of physicians, nurses, employees, board members, and volunteers brought Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system, serving more than one in three New Mexicans. We are part of New Mexico's history and committed to its future. That is why we will continue to work just as hard and care just as deeply to serve New Mexico for years to come. Connect with the Presbyterian Recruiting Team! FIRST, we want to reputed company sure you’re in the right reputed company. To provide you with the most accurate job recommendations and updates, please choose the appropriate Career Portal: For Physicians, Midlevel Providers and Advanced Practice Professionals, connect with us here: Provider Career Site For Nursing Professionals (LPN & RN), connect with us here: Nursing Career Site For reputed company Other Career Types, please continue the sign up process on this page Apply tot his job Apply To this Job