HEDIS-HCC Outreach Interventionist

Location Address:

Compensation Pay Range:

Summary:

Responsibilities:

This position is responsible for assisting in closing Quality related gaps in care for HEDIS, Risk Adjustment, and Medicare STARS through measure-specific outreach. This position also includes performing courier services throughout the state to provide telephonic equipment and other testing equipment, such as diabetic retina scanning devices and bone density machines, to members in their home. This position works within the Population Health and Quality structure in collaboration with Clinical Operations to help support members with their health needs and social determinants of health. Supports the Centralized Outreach and Engagement model for the Center of Excellence.

Some key responsibilities include:

• Speak with members in all lines of business and perform behavioral interviewing techniques, such as Motivational Interviewing, to determine social determinants of health and assist with providing support related to housing, food, transportation, etc.
• Develop and maintain relationships with Quality program participants, community partners, and key organizations.
• Coordinate services with community-based agencies, as needed, to assist in Quality care gap closure.
• Provide education of PHP and community-based programs to support the overall health of members that supports Quality care gap closures.
• Compassionately own problem through to resolution on behalf of the member in real time or through comprehensive and timely follow-up with the member.
• Collaborate with Clinical Operations and Presbyterian Medical Group to provide in-home blood pressure readings and other screenings to offer support for members health initiatives.
• Perform outreach to assigned members of Medicare Advantage throughout their entire first year of the members enrollment, to help with Senior Health overall satisfaction and first-year retention.
• Manage a panel of members assigned throughout the year specifically to them of Medicare Advantage first-year enrollment.
• Perform outreach and scheduling for Annual Wellness Visits in support of the Medicare Advantage Risk Adjustment initiative.
• Perform high level claims assistance as needed during routine outreach interventions.
• Develop and maintain strong working relationships with members to include following up with members to ensure proper guidance of health services to ensure Quality care gap closures.

Qualifications:

• High School Diploma required. Associate degree preferred.
• 3 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
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.

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.