Quality Outreach Interventionist

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 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 14000 employees it is the largest private employer in the state serving over 580000 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.