HEDIS-HCC Outreach Interventionist

Now hiring a HEDIS-HCC Outreach Interventionist

This position is responsible for assisting in closing gaps in care for HEDIS, Risk Adjustment, and Medicare STARS through measure-specific outreach. This position also can include performing courier services throughout the state to provide telephonic equipment, bone density equipment, and diabetic eye exam equipment to members in their home. This position works in collaboration with Clinical Operations and Population Health 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.

How you belong matters here.

We value our employees' differences and find strength in the diversity of our team and community.

At Presbyterian, it's not just what we do that matters. It's how we do it - and it starts with our incredible team. From Information Technology to Food Services and beyond, our non-clinical employees make a meaningful impact on the healthcare provided to our patients and members.

Why Join Us

• Full Time - Exempt: Yes
• Job is based Rev Hugh Cooper Admin Center
• Work hours: Days
• Benefits: We offer a wide range of benefits including medical, wellness program, vision, dental, paid time off, retirement and more for FT employees.

• Associate degree preferred. High School Diploma required.
• 3 years of healthcare experience required
• Call center experience preferred
• Knowledge of related medical terminology *Excellent driving record

• 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 program participants, community partners, and key organizations.
• Coordinate services with community-based agencies, as needed.
• Provide education of PHP and community-based programs to support the overall health of members.
• 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 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.
• Assist with assignment of providers with connection to both primary and specialty care.
• Perform outreach and scheduling for Annual Wellness Visits in support of the Medicare Advantage 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.
• Travel to members homes and provide electronic equipment to complete telehealth appointments with providers.
• Perform bone density scans with portable device in members homes.
• Answer inbound calls regarding rewards and benefits associated to vendor specific platforms, such as Solutran, Wellth, etc.
• Assist with enrollment in rewards programs such as Pregnancy Passport.
• Perform diabetic retinal eye screenings in members homes with portable machine.
• Participate in health-related community events and conferences to offer scheduling and preventive screening devices.
• Perform outreach relating to gap closure for HEDIS and Medicare STARS to members in all lines of business.
• Motivate members to be an active engaged participant in their health
• Maintain accurate records by documenting all contacts, services provided, and outcomes for future reference when interacting with members.
• Support outreach needs related to projects for gap closure, such as Lets Get Checked, Cologuard kits, Assured Imaging events, etc.
• Outreach to members in the Children in State Custody (CISC) population for reminders on routine screenings needed.
• Work independently to outreach to other clinics/pharmacies/DME providers/etc. relating to lists of members who are hard to reach or have incorrect numbers listed.
• Answer inbound emails relating to programs, rewards, etc, within the Performance Improvement department.
• Track and manage all information related to outreach within internal systems to allow for export of data to leadership and reporting agencies.
• Communicate with AHWA providers through Epic and internal messaging system, such as Microsoft Teams, as needed.
• Provide in-home screening test results to appropriate providers and teams to allow for follow-up care to be completed.
• Work with peers, leadership and other departments to optimize closures in gaps of care and HCCs.
• Must be willing and able to drive own vehicle to perform tasks, as needed.
• All other duties and projects as assigned.

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.

Inclusion and Diversity
Our culture is one of knowing and respecting our patients, members, and each other. We capture this in our Promise and CARES commitments.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.

USD $32.17/Hr.

The compensation range for this role takes into account a wide range of factors, including but not limited to experience and training, internal equity, and other business and organizational needs.