Quality Care Member Advocate

Centene Management Company•Pittsburgh, PA

6d•Hybrid

About The Position

The Quality Care Member Advocate serves as a link between members and the healthcare system, focusing on improving health outcomes by identifying and closing care gaps. The role emphasizes community engagement, member education, and collaboration with providers and internal teams to help members receive timely, appropriate care and support. This hybrid position combines remote work and in-person home visits, with approximately 50% of time dedicated to each. The standard schedule is Monday through Friday, 8:00 a.m. to 5:00 p.m., with flexibility required to meet members’ needs and accommodate visit schedules. Candidates must be based in or near Allegheny County. Mileage reimbursement is provided for community travel for member visits.

Requirements

Bachelor’s degree in Social Work, Public Health, Nursing, or a related field, or equivalent experience.
At least 2 years of experience in community health or healthcare quality.
Experience working with health plan members and navigating community resources.
Familiarity with Medicaid and Medicare programs and quality measures such as HEDIS.
Strong communication and interpersonal skills.

Nice To Haves

Licensed Clinical Social Worker (LCSW).
Registered Nurse (RN) with state licensure and/or compact state licensure.

Responsibilities

Conduct community outreach to identify care gaps and connect members with appropriate healthcare services and resources.
Perform home visits or community-based assessments to evaluate member needs and identify social determinants of health that may prevent access to preventive or follow-up care.
Facilitate care coordination and help members navigate healthcare and social service systems.
Assist members with scheduling appointments, understanding care plans, and accessing benefits or entitlements.
Collaborate with providers by sharing quality performance data, such as HEDIS and CAHPS, and supporting improvement initiatives.
Educate members about preventive care, chronic condition management, and available community resources.
Document member interactions, care gap closures, and referrals in appropriate systems.
Partner with internal departments, including Quality, Care Management, and Provider Relations, to align efforts and improve member outcomes.
Monitor and report on outreach effectiveness and care gap closure metrics.
Maintain compliance with state and federal regulations and organizational policies.
Participate in seasonal campaigns and quality initiatives to improve member engagement and health outcomes.
Build relationships with local organizations and stakeholders as a community ambassador.
Perform other duties as assigned and comply with all policies and standards.