VP, Health Plan Quality & Star Rating Programs

Presbyterian Healthcare Services; Albuquerque (NM); Hybrid; USD 180,000 - 280,000; Full time

Benefits offered by this job

Medical coverage (full)

Retirement plan with employer match

Paid time off

Wellness programs

Education opportunities

Life insurance

Disability programs

FSAs

Job summary

Presbyterian Healthcare Services in Albuquerque seeks a strategic Vice President of Quality to lead quality improvement and accreditation activities across plans, ensuring NCQA accreditation, Star ratings, and compliance with Medicaid and regulatory requirements.

The role directs CQI programs, designs continuous quality infrastructure, and partners with executives to advance patient care quality while managing a multidimensional team and budget.

Qualifications

• Bachelor's degree in Health Care Administration, Public Health, Nursing, or related field required.
• 10+ years progressive leadership in Quality Improvement programs.
• Active clinical licensure required; RN licensure preferred.
• CPHQ certification preferred.
• Experience with Medicaid regulations and NCQA accreditation required.
• Experience in managed care organization preferred.

Responsibilities

• Lead development and management of quality improvement and accreditation activities.
• Oversee NCQA reaccreditation and regulatory compliance.
• Direct Star ratings and Medicare/Medicaid initiative programs.
• Lead CQI processes and collaborate with PHP/PHS entities.
• Manage staff and budget for quality programs.
• Coordinate with providers and accreditation bodies.

Skills

Leadership

Quality improvement

Budget management

Regulatory compliance

Education

Bachelor's degree in Health Care Administration/Public Health/Nursing

Master's degree in related field

Active clinical licensure

RN licensure preferred

CPHQ certification preferred

Tools

NCQA accreditation

Medicaid regulations

Job description

Presbyterian Healthcare Services in Albuquerque seeks a strategic Vice President of Quality to lead quality improvement and accreditation activities across plans, ensuring NCQA accreditation, Star ratings, and compliance with Medicaid and regulatory requirements.

The role directs CQI programs, designs continuous quality infrastructure, and partners with executives to advance patient care quality while managing a multidimensional team and budget.