Quality Outreach Interventionist at Presbyterian Healthcare Services

Albuquerque, New Mexico, United States -

Full Time

Start Date

Immediate

Expiry Date

28 Jan, 26

Salary

33.14

Posted On

30 Oct, 25

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Healthcare Experience, Member Relationship Management, Risk Adjustment, Medicare STARS, Data-Driven Outreach, Concierge-Level Support, Medical Terminology, Bilingual-English/Spanish, Motivational Interviewing, Claims Assistance, Community Resources, Quality Outcomes, HEDIS, Telehealth, In-Home Screening, Behavioral Interviewing

Industry

Hospitals and Health Care

Description

Overview 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 Qualifications 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. Responsibilities 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. Benefits 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. Maximum Offer for this position is up to USD $33.14/Hr. Compensation Disclaimer The compensation range for this role takes into account a wide range of factors, including but not limited to experience and training, internal equity, and other business and organizational needs.

Responsibilities

The Quality Outreach Interventionist manages a panel of Medicare Advantage members to support wellness visit scheduling and risk adjustment documentation. They conduct outreach to improve member satisfaction and quality outcomes while providing support for navigating benefits and community resources.