Quality Care Member Advocate

Centene Management Company•Portland, ME

6d•Hybrid

About The Position

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 with in-person home visits, with approximately 50% of time allocated to each. The standard schedule is Monday through Friday, 8:00 a.m. to 5:00 p.m., with flexibility needed to meet member needs and accommodate visit schedules. Candidates must be based in or near Androscoggin County. Mileage reimbursement is provided for community travel for member visits. The position conducts community outreach, performs home or community-based assessments, identifies social determinants of health that may impede access to care, and facilitates care coordination. It helps members navigate healthcare and social service systems, arrange appointments, understand care plans, and access benefits or entitlements. The advocate also collaborates with providers and internal teams, educates members, documents outreach and care gap closures, monitors effectiveness, and participates in quality and seasonal initiatives. The role serves as a community ambassador and performs other duties as assigned while complying with applicable policies and standards. Centene describes its work as supporting individuals, families, and communities by making healthcare more accessible and effective. Compensation is $27.02–$48.55 per hour, adjusted based on skills, experience, education, and other job-related factors permitted by law. Total compensation may include additional incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer.

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.
Must be based in or near Androscoggin County.
Flexibility to meet member needs and accommodate visit schedules.
LCSW (Licensed Clinical Social Worker) preferred.
RN state licensure and/or compact state licensure preferred.

Nice To Haves

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

Responsibilities

Conduct community outreach to identify member 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.
Help members navigate healthcare and social service systems.
Assist members with scheduling appointments, understanding care plans, and accessing benefits or entitlements to close care gaps and maintain continuity of care.
Collaborate with providers by sharing quality performance data, including 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.