Quality Care Member Advocate

Centene Corporation•Pittsburgh, PA

12d•$27 - $49•Hybrid

About The Position

Serves as a vital link between members and the healthcare system, focusing on improving health outcomes by identifying and closing care gaps. This role emphasizes community engagement, member education, and collaboration with providers and internal teams to ensure members receive timely, appropriate care and support. This hybrid position is designed to support meaningful member engagement through member education, community resources, and collaboration with providers to ensure members receive care and support. There is a balanced combination of 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; however, flexibility is a key requirement to effectively meet members’ needs, accommodate visit schedules, and ensure high-quality service delivery. Candidates must be based in Allegheny County. Mileage reimbursement is provided for travel in the community for member visits.

Requirements

Bachelor's Degree Social Work, Public Health, Nursing, or related field; or equivalent experience required
2+ years In community health or healthcare quality required
Experience working with health plan members and navigating community resources required
Familiarity with Medicaid / Medicare programs and quality measures (e.g., HEDIS) required
Strong communication and interpersonal skills

Nice To Haves

LCSW- License Clinical Social Worker preferred
RN - Registered Nurse - State Licensure and/or Compact State Licensure preferred

Responsibilities

Conduct outreach to members in the community to identify care gaps and connect them 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 members from accessing preventive or follow-up care, and facilitate care coordination.
Serve as a member advocate by helping individuals navigate complex healthcare and social service systems. Assist with scheduling appointments, understanding care plans, and accessing benefits or entitlements, ensuring members receive the support needed to close care gaps and maintain continuity of care.
Collaborate with providers to share quality performance data (e.g., HEDIS, CAHPS) and support improvement initiatives.
Educate members on preventive care, chronic condition management, and available community resources.
Document member interactions, care gap closures, and referrals in the appropriate systems.
Partner with internal departments (e.g., Quality, Care Management, 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.
Serve as a community ambassador, building relationships with local organizations and stakeholders.
Performs other duties as assigned.
Complies with all policies and standards.