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Location Address: 9521 San Mateo NE Albuquerque, NM 87113-2237
Summary: The Executive Director of Medical & Healthcare Economics serves as a strategic enterprise leader, driving the transformation of care delivery and financial performance across the health plan and the integrated health system. This executive role is accountable for architecting and advancing medical economics capabilities, shaping reimbursement and policy strategies that align with organizational goals. Through deep collaboration with clinical, actuarial, financial, and operational leaders, the VP ensures that economic insights translate into actionable strategies that enhance quality, reduce cost, and improve member outcomes. The role is a key influencer in enterprise innovation, regulatory alignment, and strategic decision-making. Serve as a key communicator and strategic advisor across executive, clinical, operational stakeholders and external stakeholders.
Job Description: * Provide executive oversight for the design, implementation and management of a Medical Economics function at the health plan focused on total cost of care, provider / network performance, value-based care and Med Econ reporting
* Lead research and forecasting on emerging medical trends, technologies, and cost-effectiveness to inform strategic planning to impact medical costs
* Accountable to the PHP President, CMO and CFO to establish near term and long term PHP med econ priorities
* Drive cross-functional strategy development to align member economics with PHS system-wide priorities and serve as an advisor to PHS delivery system leadership
*Engage external stakeholders such as large employer groups, non-PHS providers and value-based care vendors in strategies to lower total cost of care
*Partners directly with PHP Actuarial Finance, PHP Finance and PHS Enterprise Finance to support actuarial, finance and budgeting needs of the health plan and the enterprise
*Collaborates with CMO, VP Population Health, VP Pharmacy, VP Provider Networks, and VP Claims Operations to identify and develop medical cost savings opportunities
* Establish enterprise-wide benchmarks for provider unit cost and ensure contract compliance through strategic monitoring and analytics
* Lead high-impact financial modeling and scenario analysis to inform contract negotiations and strategic approvals
* Support payment accuracy initiatives, including claim edit reviews and savings validation, to ensure financial integrity
* Support formulary impact assessments and collaborate with pharmacy leadership to optimize cost and clinical value
* Guide advanced analytics on high-cost members and population risk profiles to inform care management and strategic interventions
* Evaluate medical policy proposals through rigorous economic and clinical impact analysis prior to implementation
* Monitor and report on ROI for clinical programs and strategic initiatives, ensuring alignment with enterprise goals
* Develop and scale medical cost savings measurement in conjunction with PHP Transformation Offce.
* Oversee enterprise deliverables including LODs, fee schedules, and regulatory documentation with strategic sign-off authority
* Integrate regulatory and compliance analytics into operational and strategic frameworks Additional Job Description: * Master's degree in Health Economics, and/or degree in Mathematics / Statistics required
* 8+ years of experience in actuarial finance, network management, or healthcare analytics required
* Proven leadership in an integrated delivery system
* Strong understanding of healthcare reimbursement models and regulatory frameworks
* Excellent communication and cross-functional collaboration skills
* Experience influencing policy and driving enterprise innovation
* Health plan government payer product management experience highly preferred 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
Presbyterian Healthcare Services is a locally owned, not-for-profit healthcare system ofnine 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 blend 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 make this state great.
Cities in New Mexico are continually ranked among the nation's best places to work and live by Forbes 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 all available among our beautiful wonders of the west.
AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.
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Presbyterian Healthcare Services
life insurance, vision insurance, paid time off, long term disability
Mar 04, 2026