Clinical Content & Policy Program Manager

Location Address:

Compensation Pay Range:

Summary:

Responsibilities:

The Clinical Content & Policy Program Manager is responsible for development, management, and oversight of clinical program documentation and healthcare policy interpretation across the health plan enterprise. This role serves as a strategic liaison between clinical operations, product, provider relations, and communications teams to ensure accurate, consistent, and regulatory-aligned clinical content.

Some key responsibilities include:

• The position leads the creation and maintenance of provider-, employer-, and member-facing clinical content used to support organizational initiatives, program education, marketing materials, and external business communications. The role also interprets federal and state healthcare policy requirements and translates regulatory guidance into operational and clinical program language.
• This position requires strong healthcare operational knowledge, exceptional writing and communication skills, and the ability to synthesize complex clinical and regulatory information into clear, audience-appropriate content.
• Clinical Program Documentation
• Develop, maintain, and oversee enterprise clinical program descriptions and supporting documentation.
• Create and update documentation for care management, utilization management, population health, quality improvement, behavioral health, and other clinical programs.
• Ensure program documentation aligns with organizational goals, accreditation standards, and regulatory requirements.
• Collaborate with clinical and operational leaders to accurately represent workflows, interventions, and program outcomes.
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• Clinical Content Development
• Develop provider-, employer-, and member-facing content that communicates clinical programs, health plan initiatives, and healthcare services.
• Create content for educational materials, program marketing collateral, implementation guides, external communications, and organizational publications.
• Support development of clinical narratives and content incorporated into organizational business materials, program overviews, and strategic communications.
• Ensure all clinical content is accurate, audience-appropriate, compliant, and aligned with organizational messaging standards.
• Maintain consistency of terminology, tone, and clinical messaging across enterprise materials.
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• Regulatory & Policy Interpretation
• Monitor and interpret federal and state healthcare regulations, guidance, and policy updates impacting clinical programs.
• Analyze implications of regulatory changes and collaborate with operational leaders to support implementation.
• Translate complex clinical healthcare regulations into actionable operational and program language.
• Support organizational readiness related to CMS, state Medicaid, Medicare Advantage, NCQA, and other regulatory or accreditation requirements.
• Assist with policy review and documentation updates to maintain regulatory compliance.
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• Cross-Functional Collaboration
• Partner with clinical operations, compliance, legal, quality, population health, communications, provider relations, and product teams to develop integrated content and program documentation.
• Facilitate stakeholder reviews and ensure alignment across departments.
• Serve as a subject matter resource for clinical program language, healthcare policy interpretation, and content standardization.
• Support enterprise initiatives requiring clinical documentation, operational narratives, or regulatory communication.

Qualifications:

• Bachelor's degree in Nursing, Healthcare Administration, Public Health, Communications, or related field required.
• Minimum of 5 years of experience in healthcare, health plan operations, clinical program management, medical policy, healthcare communications, or related field.
• Experience developing clinical, operational, or healthcare regulatory documentation.
• Strong understanding of healthcare delivery systems, managed care, Medicare, Medicaid, and population health programs.
• Demonstrated ability to interpret and apply healthcare regulations and accreditation standards.
• Exceptional written, verbal, and organizational communication skills.
• Strong project management and cross-functional collaboration abilities.

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Preferred Qualifications

• Master's degree in Healthcare Administration (MHA), Public Health (MPH), Business Administration (MBA), Nursing, or related field preferred.
• Clinical licensure (RN, LCSW, or other healthcare licensure) preferred.
• Experience with NCQA, CMS, Medicaid, or Medicare Advantage regulatory frameworks preferred.
• Experience in healthcare communications, clinical strategy, or enterprise content development preferred.

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Core Competencies

• Clinical Program Strategy
• Healthcare Policy Interpretation
• Regulatory Compliance
• Healthcare Content Development
• Clinical Documentation
• Population Health
• Managed Care Operations
• Cross-Functional Leadership
• Strategic Communication
• Program Development
• Process Improvement
• Stakeholder Engagement

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Reporting Structure
Reports to VP Clinical Operations, Initiatives, and Strategy
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Working Conditions

• *Hybrid or remote work environment may be available based on organizational needs.
• *Occasional participation in cross-functional meetings, audits, or strategic planning sessions required.
• Ability to manage multiple priorities and deadlines in a fast-paced healthcare environment.

All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.

Wellness
Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.

Why work at Presbyterian?
As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans.

About Presbyterian Healthcare Services
Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses.

Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.