Presbyterian Healthcare Services · 2 hours ago
Chief Behavioral Health & Quality Officer
United States
Full-time
Remote
Director/Executive
8+ years expPresbyterian Healthcare Services is a not-for-profit healthcare system in New Mexico, and they are seeking a Chief Behavioral Health & Quality Officer. This role is responsible for leading behavioral health initiatives and programs, ensuring compliance, and overseeing vendor performance while promoting health equity and quality performance across various lines of business.
AssociationHealth Care
Responsibilities
Ensure compliant operation of PHP’s Children in State Custody program and manage reputational risk
Develop proactive monitoring processes for CISC and behavioral health contractual requirements
Build and maintain outreach strategies with key stakeholders, including providers and community organizations
Identify opportunities and risks related to behavioral health priorities and lead responsive initiatives
Oversee behavioral health vendor performance, ensuring integration of clinical services and contractual compliance
Lead 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
Develop 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
Oversee behavioral health reporting for all lines of business and maintain quality performance metrics
Promote behavioral health managed care concepts and cost-of-care strategies within the community
Develop policies, procedures, and workflows for all managed behavioral health functions
Provide leadership for staff development, training, and succession planning within the Behavioral Health Department
Own the health plan’s risk adjustment strategy and results for behavioral health and CISC-related populations across Medicaid, Medicare Advantage, and Commercial/Exchange lines of business
Drive accurate, compliant diagnosis capture (e.g., HCCs) through provider documentation education, coding integrity programs, and collaboration with care management and quality teams
Establish a behavioral health coding integrity program that includes prospective, concurrent, and retrospective reviews; monitor for compliance with CMS/HHS and state regulations, and prevent any upcoding or inappropriate practices
Lead 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
Develop suspect-driven outreach 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 contracts (including delegated BH vendors) with clear SLAs for risk adjustment, encounter data, analytics, and provider enablement
Lead provider engagement programs (training, toolkits, onsite/virtual consultations) to improve documentation quality for BH and pediatric complex 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 oversight
Qualification
Required
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
Master's degree in Public Health, Health Administration, Social Work, Psychology, or related field
Certification(s): CRC (Certified Risk Adjustment Coder) 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
Benefits
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
Company
Presbyterian Healthcare Services
Presbyterian Healthcare Services exists to improve the health of patients, members and the communities they serve.
10001+ employees
H1B Sponsorship
Presbyterian Healthcare Services has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (90)
2024 (86)
2023 (85)
2022 (93)
2021 (86)
2020 (76)
Funding
Current Stage
Late StageLeadership Team
Dale Maxwell
President and CEO
Ernest Sanchez
Chief Technology Officer
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