Quality Outreach Interventionist bei Presbyterian Healthcare Services
Presbyterian Healthcare Services · Albuquerque, Vereinigte Staaten Von Amerika · Onsite
- Professional
- Optionales Büro in Albuquerque
Presbyterian is seeking a Quality Outreach Interventionist
This position serves as a key member of the Centralized Outreach & Engagement team, responsible for advancing Quality, Risk Adjustment, and Medicare STARS performance through high-level coordination and member relationship management. This position manages a panel of members to support Annual Wellness Visit scheduling, HCC documentation, and first-year Medicare Advantage retention. This position also conducts specialized outreach to address risk adjustment and satisfaction drivers, such as CAHPS and HOS measures, while providing concierge-level support to help members navigate benefits, providers, and community resources. In collaboration with Clinical Operations and Population Health, this role combines data-driven outreach with empathetic service to deliver measurable improvements in member experience and clinical quality.
- This is a Full Time position - Exempt: Yes
- Job is based at Rev Hugh Cooper Admin Center
- Work hours: Days
- High School Diploma required. Associate degree preferred.
- Three years of healthcare experience required
- Valid drivers license & Auto Insurance required
- Call center experience preferred
- Knowledge of related medical terminology
- Excellent driving record
- Bilingual-English/Spanish preferred.
- Develop and manage a panel of members assigned throughout the year specifically to them of Medicare Advantage first-year enrollment.
- Collaborate with Clinical Operations and Presbyterian Medical Group to provide in-home blood pressure readings and other screenings.
- Provide in-home screening test results to appropriate providers and teams for follow-up.
- Perform outreach to Medicare Advantage members to support Quality outcomes related to CAHPS and HOS.
- Perform outreach and scheduling for Annual Wellness Visits (AWVs) in support of Risk Adjustment initiatives.
- Perform high-level claims assistance during outreach interventions.
- Assign activities within internal systems to ensure timely follow-up.
- Expected to demonstrate flexibility by performing tasks from lower-level roles when necessary to meet organizational metrics and member needs.
- Travel to members homes to provide telehealth or testing equipment for Risk Adjustment and Quality gap closures.
- Perform bone density scans in members homes for the Medicare Stars osteoporosis measure.
- Assist with assignment of members to primary and specialty care providers.
- Speak with members in all lines of business and perform behavioral interviewing techniques (Motivational Interviewing) to determine social determinants of health.
- Provide education of PHP and community-based programs that support quality care gap closures.
- Perform outreach relating to HEDIS, Risk Adjustment, Medicare STARS, and other regulatory entities.
- Must research and provide feedback to ensure provider/member activities meet HEDIS and regulatory requirements.
- Track and manage outreach information in internal systems for leadership reporting.
- Motivate members to be actively engaged participants in their health.
- Compassionately own member issues through resolution or escalation.
- Other duties and projects assigned.
About Presbyterian Healthcare Services
Presbyterian offers a comprehensive benefits package to eligible employees, including medical, dental, vision, disability coverage, life insurance, and optional voluntary benefits.
The Employee Wellness Rewards Program encourages staff to engage in health-enhancing activities - like challenges, webinars, and screenings - with opportunities to earn gift to earn gift cards and other incentives.
As a mission-driven organization, Presbyterian is deeply committed to improving community health across New Mexico through initiatives like growers' markets and local partnerships. Founded in 1908, Presbyterian is a locally owned, not-for-profit healthcare system with nine hospitals, a statewide health plan, and a growing multi-specialty medical group. With nearly 14,000 employees, it is the largest private employer in the state, serving over 580,000 health plan members through Medicare Advantage, Medicaid, and Commercial plans.
AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.
