Presbyterian Healthcare Services

Procurement

• Ensure adequate stock of pharmaceuticals.
• Serves as supplier and purchasing consultant to regional hospitals and clinics.
• Ensures contract compliance and correct pricing for all purchases.
• Provide pharmacy administration with monthly financial, purchasing, and issues reports.
• Interacts with pharmaceutical representatives to ensure adequate service levels.
• Research short-supply items, find alternative sources, and obtain emergency pharmaceuticals when required.
• Communicate with pharmacy staff on the availability of pharmaceuticals.
• Processes all drug recalls and checks stock for recalled items.
• Responsible for adherence to the Department Compliance Plan for Controlled Substances.
• Review wholesaler reports for unpaid invoices.
• Tracks invoices with Accounts Payable.
• Conducts complete inventories of stock and completes reports.
• Perform other functions as required.

Pharmacy Procurement Agent – Infusion Center

Manager

• The Pharmacy Manager will assist in managing all aspects of Presbyterian Pharmacy Services daily operations for the Delivery System.
• Type of Opportunity: Full Time (1.0 FTE/40 hours per week)
• Supervises daily work schedules, assigns personnel, and ensures adequate staffing for the daily operation of the Presbyterian pharmacy departments.
• Ensures qualified clinicians are held accountable to the organization for decisions affecting consumers.
• Assists in selection training and orientation of departmental staff.
• Evaluates work performance and makes recommendations for personnel action.
• Establishes and maintains departmental policy and procedures, safety, environmental, regulatory, and infection control standards.
• Acts as liaison with other departments, and medical staff concerning the medication use process including ordering, distribution, information, patient reactions, errors, and complaints.
• Enhances professional growth via participation in external and in-house education programs, current literature reviews, and workshops.
• Responsible for staff awareness and adherence to the Department Compliance Plan for Controlled Substances.
• Assist in the investigation of controlled substance discrepancies/concerns.
• Responsible for utilizing financial, labor, productivity reports, and data to manage departmental performance to meet PHS targets.

Pharmacy Administration Manager

Analyst

• Provide basic configuration and maintenance for production applications
• Provide a variety of basic technical tasks related to assigned area of responsibility
• Work directly with business units and other stakeholders to gather business requirements
• Use basic analytical and problem solving skills and understanding of the business and systems to resolve problems with production applications
• Participate with testing and validation efforts
• Participate in review, impact assessment, testing and modifications for application updates, upgrades and installations
• Work with end users to identify needs and resolve problems
• Gather and create business requirements
• Project work and independent decision making

Associate Configuration Analyst

Sales

• Manage the administrative and sales functions within the commercial sales retention teams and develops quality improvement initiatives.
• Supports all aspects of Sales retention team to ensure goals and objectives are met.
• In conjunction with all Sales Management Team ensures that the department maintains compliance with all regulatory requirements.
• Designs and implements annual sales plans for securing and maintaining market share.
• Manages the renewal process for all commercial group products.
• Develops and maintains positive relationships with business, partners, such as brokers, consultants, etc.
• Responsible for the ongoing training of staff for continuous sales skills improvement, rating and underwriting methodology and professional development.
• Direct and supports sales staff and their efforts in the market.
• Ensures that the department maintains compliance with CMS, NMOSI, and PHP/PIC regulations and standards as they apply to sales and marketing of commercial group products.
• Evaluate and implement new distribution or product management systems.
• Monitors and ensures internal sales processes are followed and implement improvements/change when necessary.

Commercial Sales Manager

• Independent ownership and responsibility for payment accuracy financial recovery work to ensure accurate provider claims payment and support lowering the total cost of care for all lines of business - Medicaid, Medicare, Commercial and ASO.
• Manage post-payment reviews and audits to identify overpayments, duplicate claims, and billing anomalies securing financial recourse for the health plan.
• Manage multiple cross functional teams and vendors -SIU, external vendors and internal PHP teams to validate findings and initiate recovery actions with each independent agency.
• Leads audit and reviews on adjudication and coding errors to ensure on time and accurate payment.
• Own end to end executive level business process and data analysis across all provider reimbursement methods, influencing our partners by telling the right story with data.
• Own maintaining accurate claims payment to support the success of the ongoing payment accuracy identification and recovery for the health plan.
• Build, maintain, track and report recovery performance, ROI, and trends using dashboards and analytics tools.
• Accountable for strategic decision making to ensure accuracy, timeliness and clear communication of the payment accuracy recovery operation for the health plan.
• Lead prospective payment integrity efforts by identifying patterns and recommending edits or policy changes to prevent future errors and overpayments, reading out on trends to executive PHP leadership and developing mitigation strategies.
• Collaborate with finance, compliance, and provider relations to ensure accurate and timely resolution of recovery cases.
• Establish process for documentation and governance in accordance with regulatory and contractual requirements for payment accuracy of the health plan.
• Responsible for holding providers accountable through facilitating compliance with provider contracts.
• Point of contact for identifying and resolving outlier billing errors.
• Responsible for communication between PHP payment accuracy team and provider and partner business offices.

Payment Accuracy Recovery Analyst – Associate

Insurance

• Investigates, evaluates, and negotiates more severe and complex claims and litigation to a successful resolution and in compliance with company standards.
• Investigate, evaluate, and negotiate claims, primarily medical malpractice but may include Directors and Officers, general and premises liability, property damage of more severe and complex nature.
• Maintain claims database documentation, appropriate reserving and case strategy.
• Direct PHS participation in defense of claims and litigation at direction of risk director and risk attorney.
• Provide general assistance and support to risk management and legal activities.
• Manage claims and litigation matters from inception to closure including identification and investigation of coverage, liability and damages issues.
• Establish and execute appropriate and economical plan for claim resolution in compliance with department/carrier best practices and guidelines.
• Review, analyze, research, and prepare responses for discovery; gather, organize and index requested documents including electronic discovery for interrogatories, requests for production, subpoena, and motions.
• Draft frequent and complex claim related correspondence.
• Prepare claim reports and educates organization about risk issues identified through claims data.
• Attend and participate in settlement negotiations and negotiates within authority; attend mediation and trials related to claims or litigation.
• Manage relationships and provide support for internal and external customers; serve as primary source of contact and support for employees named or involved in claims/lawsuits.
• Direct and control activities of outside vendors, including defense counsel and experts.

Claims Adjuster II – Complex Litigation

Therapist

• Assist with ongoing patient mobility including bed mobility/repositioning, transfers, and ambulation of hospital inpatients
• Provide emotional support to patients and their families
• Assist patients with feeding and activities of daily living, including toileting, bathing, dressing, and grooming
• Perform phlebotomy and other collection procedures appropriately and according to established procedures
• Process requisitions and enter test orders into the computer system; retrieve and print collection labels
• Receive, process and/or store specimens, centrifuging, splitting, acidifying, aliquoting, measuring and stabilizing
• Perform waived and moderate complexity testing where trained and competent
• Perform routine equipment maintenance and function checks; order and maintain supplies and inventory
• Ensure compliance with regulatory agencies and biohazard disposal as needed
• Assist clinical floor staff with stocking supplies, cleaning, patient transport and other tasks
• Greet and direct customers; promote accurate and timely unit communication; keep locator boards current
• Answer telephones, transcribe physicians orders, and process paperwork for admissions, transfers and discharges
• Maintain Medical Record completeness at discharge, correct census and bed status, and assemble patient charts
• Monitor, collect and record patient information including vital signs, weights, input/output
• Transport patients and document actions in patient record; participate in nutritional well-being and tray delivery
• Assist with activities of daily living, positioning and ambulation; report pertinent information to responsible nurse
• Insert and remove gastric and urethral tubes; perform enemas and disimpactions; remove peripheral IV lines
• Operate patient monitoring systems and perform bedside testing such as oximetry, ECG, glucometry, urinalysis
• Perform wound care and dressing changes; remove staples and sutures; assist with sterile procedures
• Apply and assist with oxygen delivery devices and restraints under RN direction
• Document all care in the patient record and use computerized documentation systems
• Deliver specimens to Laboratory, Microbiology and Pathology; transport x-rays, blood products and equipment
• Maintain cleanliness of nutrition areas, clean and store equipment, empty trash/linen/sharps, and inventory equipment
• Perform other duties as assigned

Patient Mobility Technician – Physical Therapy, Inpatient

Executive Assistant

• Perform secretarial/clerical duties and act as a communication center for the nursing unit
• Perform specific patient care procedures (bedside testing, phlebotomy) under RN direction
• Operate patient monitoring systems and perform routine bedside testing (Oximetry, ECG, Glucometry, urinalysis)
• Process requisitions, enter test orders, label and deliver specimens to Laboratory/Microbiology/Pathology
• Receive, process, centrifuge, aliquot, store and dispose of specimens as appropriate
• Maintain unit census, bed status, locator boards, and assemble/organize patient charts
• Answer phones, transcribe physician orders, and communicate paperwork for admissions/transfers/discharges
• Stock supplies, clean and maintain equipment, perform biohazard disposal, and ensure regulatory compliance
• Transport patients, x-rays, blood products and equipment; assist with patient ambulation and ADLs
• Assist nurses and physicians with sterile procedures, wound care, suture/staple removal, and application of restraints/oxygen as directed
• Document all care provided in the patient record using EPIC or computerized documentation systems
• Perform other duties as assigned to support unit operations and patient care

Unit Secretary / Nursing Tech

Financial Planning and Analysis

• Serve as key individual contributor to review and analyze directives from the New Mexico Health Care Authority (HCA) for PHP’s Medicaid program
• Ensure financial compliance and review adequacy of funding for directives
• Support provider rate implementations and perform provider rate reconciliations
• Partner with Medical Economics and multiple business areas for directive compliance
• Audit implemented rates to ensure accurate payment on claims and prevent over/under payment
• Reconcile provider rates in PHP’s claim system with HCA monthly Medicaid Floor Rates and provider agreements
• Respond to HCA directive drafts and recommend corrections
• Lead project management activities: organize, schedule, plan, manage timelines and senior-level team activities
• Create and deliver executive-level presentations and briefings for senior leadership and the Board of Directors
• Provide strategic financial analysis, support Finance Director/Managers, and act in decision-making capacity on assigned projects
• Provide leadership for finance data-marts and planning/reporting tools and technologies