Quality Outreach Interventionist
About The Position
Build your Career. Make a Difference. Presbyterian is hiring a skilled Quality Outreach Interventionist to join our team. 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.
Requirements
- High School Diploma required.
- Three years of healthcare experience required
- Valid drivers license & Auto Insurance required
- Knowledge of related medical terminology
- Excellent driving record
Nice To Haves
- Associate degree preferred.
- Call center experience preferred
- 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.
Benefits
- 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.
- Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
Number of Employees
5,001-10,000 employees
