Quality Care Member Advocate

Centene Corporation • Houston, TX

4d • $27 - $49

About The Position

The Quality Care Member Advocate serves as a link between members and the healthcare system, helping improve 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. The position supports Houston, Texas, and surrounding areas, and the employee must reside in Texas.

The advocate conducts community outreach and home or community-based assessments to identify member needs and social determinants of health that may impede access to preventive or follow-up care. The role helps members navigate healthcare and social service systems, coordinate care, schedule appointments, understand care plans, and access benefits or entitlements. The advocate also educates members, collaborates with providers and internal departments, documents interactions and referrals, tracks outreach and care-gap metrics, and participates in seasonal campaigns and quality initiatives. The position includes community relationship-building and requires compliance with applicable regulations and organizational policies.

Requirements

• Must reside in Texas.
• 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 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 interfere with 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 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.

Benefits

• Competitive pay.
• Health insurance.
• 401(k) and stock purchase plans.
• Tuition reimbursement.
• Paid time off and holidays.
• Flexible approach to work, with remote, hybrid, field, or office work schedules.
• Potential additional forms of incentives.

What This Job Offers

• Job Type: Full-time