Quality Outreach Interventionist II

Presbyterian is seeking a Quality Outreach Interventionist II

This position serves as a front-line ambassador for Presbyterian Health Plans commitment to exceptional member care, regulatory compliance, and continuous improvement. This role integrates HEDIS, Risk Adjustment, and Medicare STARS outreach with Service Recovery and Experience Excellence strategies, ensuring members receive compassionate, efficient, and solution-focused support. Using evidence-based approaches like Motivational Interviewing and AHRQ Service Recovery Frameworks, this position proactively resolves member concerns, addresses barriers to care, and drives measurable improvement in CAHPS/HOS, retention, and total cost of care. This position acts as both advocate and problem-solver, turning service challenges into opportunities for trust, education, and quality outcomes. Supports the Centralized Outreach and Engagement model for the Center of Excellence.

This is a Full Time position - Exempt: Yes
• Job is based at Rev Hugh Cooper Admin Center
• Work hours: Days

Ideal Candidate Associate degree. Four years of healthcare experience. One year of call center experience

• Associate degree. Three years of additional experience in lieu of degree
• Four years of healthcare experience required
• One year of call center experience required
• Knowledge of related medical terminology
• Bilingual-Spanish/English preferred

• Research appeals, grievances, and other customer feedback data to identify patterns, root causes, and opportunities for service recovery, ensuring a holistic understanding of the member experience.
• Execute service recovery call campaigns driven by leadership-identified triggers, such as negative survey feedback, complaint trends, or escalation reports, ensuring prompt and consistent follow-up.
• Serve as a first-line member advocate for issues arising from service gaps, dissatisfaction, or care coordination concerns.
• Apply the AHRQ Five Steps to Service Recovery: anticipate, acknowledge, apologize, amend, and analyze.
• Identify and document service recovery opportunities from CAHPS/HOS, Member Services escalations, and outreach interactions.
• Translate individual recovery cases into improvement projects, working with operations, clinical, and quality teams to prevent recurrence of common failures.
• Perform outreach to Medicare Advantage members to support Quality outcomes related to CAHPS and HOS.
• Use insights from service recovery to help leadership shape member experience strategy, member communications, and outreach protocols to reduce friction and build loyalty.
• Serve as a liaison between the member experience, Appeals and Grievances, and outreach staff to ensure alignment, timely escalation, and integration of recovery actions into daily outreach workflows.
• 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.

About Presbyterian Healthcare Services
Presbyterian offers a comprehensive benefits package to eligible employees, including medical, dental, vision, disability coverage, life insurance, and optional voluntary benefits.

The Employee Wellness Rewards Program encourages staff to engage in health-enhancing activities - like challenges, webinars, and screenings - with opportunities to earn gift to earn gift cards and other incentives.

As a mission-driven organization, Presbyterian is deeply committed to improving community health across New Mexico through initiatives like growers' markets and local partnerships. Founded in 1908, Presbyterian is a locally owned, not-for-profit healthcare system with nine hospitals, a statewide health plan, and a growing multi-specialty medical group. With nearly 14,000 employees, it is the largest private employer in the state, serving over 580,000 health plan members through Medicare Advantage, Medicaid, and Commercial plans.

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