Quality Outreach Interventionist

Now Hiring: Quality Outreach Interventionist

This work from home role is available to New Mexico residents only. Build your Career. Make a Difference. Presbyterian is hiring a skilled Quality Outreach Interventionist to join our team.

Type of Opportunity: Full time

Job Exempt: Yes

Job is based: Reverend Hugh Cooper Administrative Center

Work Shift: Days (United States of America)

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.

Some key responsibilities include:

• 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.

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.

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.

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.

Presbyterian Healthcare Services