Quality Outreach Interventionist

About the role

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)

Responsibilities

• 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.

Requirements

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

Benefits

Additional Information

Location Address: 9521 San Mateo NE Albuquerque, NM 87113-2237 Compensation Pay Range: Minimum Offer $45,136.00 Maximum Offer $68,931.20 Now Hiring: Quality Outreach Interventionist

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