Executive Director-Clinical Program Portfolio Strategy and Financial Performance

Location Address:

Summary:

Job Description:

The Executive Director, Clinical Program Portfolio Strategy and Financial Performance is responsible for leading the financial and strategic oversight of the health plan's clinical program portfolio. This role ensures that medical cost performance, utilization patterns, and market trends are rigorously analyzed and translated into actionable insights that support member affordability, value based care performance, and enterprise financial objectives.
The Executive Director partners closely with Medical Economics, Actuarial, Finance, Product, and Clinical leadership to drive disciplined portfolio management, forecast medical cost trends, and assess financial sustainability across current and emerging clinical programs.

Some key responsibilities include:

• Provide executive leadership for the financial performance management of the health plan's clinical program portfolio, with a focus on total cost of care, utilization management, and value based reimbursement models.
• Establish and maintain standardized frameworks for evaluating portfolio performance, including financial impact, trend influence, and alignment to health plan strategy.
• Support portfolio prioritization and investment decisions through performance measurement, financial modeling, and market informed analysis.
• Lead the analysis of financial, clinical, and utilization data to assess historical performance and project future medical cost trends at the portfolio, product, and population level.
• Oversee advanced financial forecasting and scenario modeling to inform budgeting, pricing, and strategic planning processes.
• Collaborate with Actuarial and Finance teams to ensure clinical program assumptions are incorporated into medical trend projections and enterprise financial plans.
• Prepare and review detailed variance analyses comparing actual performance to expected cost, utilization, and savings targets.
• Identify root causes of unfavorable performance, assess financial risk, and develop corrective action recommendations in partnership with clinical and operational leaders.
• Provide senior leadership with clear, timely insights regarding emerging risks, performance gaps, and opportunities for improvement.
• Monitor external market conditions, industry benchmarks, and evolving care models that influence medical cost performance and clinical program effectiveness.
• Assess competitiveness and value of clinical programs relative to peer health plans and regional markets.
• Integrate market intelligence into portfolio evaluations, financial forecasts, and strategic recommendations.
• Oversee the preparation of executive level financial and performance reporting to support ongoing management reviews and governance forums.
• Ensure reporting effectively communicates portfolio level insights related to medical cost containment, utilization trends, and program value.
• Partner with Product and Clinical leaders to align insights with benefit design, program enhancements, and member focused strategies.
• Serve as a strategic advisor to health plan leadership on clinical program economics, medical cost management, and portfolio optimization.
• Support long range financial planning and multi year medical cost strategies in alignment with enterprise objectives.
• Collaborate across Clinical, Medical Economics, Actuarial, Pharmacy, Provider Networks, and Operations to ensure coordinated execution of portfolio strategies.
• Build strong, collaborative relationships across actuarial, finance, clinical, and product teams to drive shared accountability for outcomes.
• Lead analytic resources ensuring high standards for analytical rigor, consistency, and interpretability.
• Promote a culture of evidence based decision making and proactive financial stewardship within the health plan.

Additional Job Description:

• 10+ years of progressive leadership experience in healthcare, health plans, or integrated delivery systems, health policy, with demonstrated accountability for financial performance, strategic planning, and clinical program oversight
• Deep expertise in health policy, population health, value-based care, and provider performance management, with the ability to evaluate clinical program effectiveness through a financial lens
• Strong understanding of Medicare, Medicaid, and Commercial lines of business, including how clinical quality, utilization patterns, and market dynamics translate into medical cost performance and financial outcomes
• Demonstrated ability to translate clinical, quality, and market performance data into financial value and impact, quantifying implications for total cost of care, trend management, and enterprise financial performance
• Proven success in linking clinical outcomes, utilization, and population health performance to financial results, including cost savings, revenue optimization, and risk mitigation
• Advanced capability to synthesize complex clinical, operational, and market data into actionable financial insights, informing pricing, forecasting, and strategic investment decisions
• Experience in medical cost trend analysis, financial forecasting, and portfolio performance management, including variance analysis, scenario modeling, and long-range planning
• Demonstrated success leading cross-functional initiatives in partnership with Actuarial, Finance, Medical Economics, Clinical, Product, and Network teams to drive aligned financial and clinical outcomes
• Preferred
• Advanced degree (MBA, MPH, MHA, or related field)
• Experience in integrated delivery systems or provider-sponsored health plans, with a strong understanding of payer-provider alignment and clinical-financial integration
• Familiarity with risk-based contracting and capitation models, including full-risk, shared savings, and alternative payment models
• Experience supporting enterprise financial strategy, including pricing, product design, and multi-year medical cost management
• Demonstrated ability to lead analytic functions or teams, ensuring rigor, standardization, and translation of insights into business value
• Core Competencies
• Strategic Thinking & Enterprise Leadership
• Sets enterprise strategy by connecting clinical performance, market dynamics, and financial outcomes to organizational priorities
• Provider Impact & Influence
• Aligns providers and clinical leaders by clearly linking care delivery performance to financial and value-based outcomes
• Data-Driven Decision Making
• Translates complex clinical, quality, and market data into clear financial insights that guide executive decision-making
• Financial & Operational Acumen
• Deep expertise in interpreting clinical and utilization data to drive medical cost management, forecasting, and financial sustainability
• Cross-Functional Collaboration
• Partners across clinical, actuarial, finance, and operational teams to ensure alignment between performance insights and financial results
• Commitment to Health Equity & Patient-Centered Care
• Ensures equity and patient-centered outcomes are embedded in financial and clinical program evaluation
• Success Profile
• The ideal candidate is a strategic, analytically rigorous, and execution-focused leader who excels at translating clinical and market performance into financial value. This individual:
• Bridges clinical and finance by connecting clinical outcomes, utilization, and quality performance directly to financial impact
• Aligns stakeholders around a shared understanding of how clinical strategy drives economic value and sustainability
• Brings credibility with clinicians and executives by articulating the financial implications of care delivery decisions
• Demonstrates the ability to turn complex data into clear, actionable financial strategies that improve cost, quality, and utilization
• Leads effectively in matrixed organizations, driving accountability for both clinical performance and financial outcomes
• Balances long-term strategic vision with disciplined execution, ensuring measurable and sustainable portfolio performance
• Champions innovation and continuous improvement while advancing health equity through financially sustainable care models

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.