Quality Care Member Advocate

Centene Management Company•Houston, TX

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 so members receive timely, appropriate care and support. The role must be based in Texas and supports Houston and surrounding areas. The advocate conducts community outreach and home or community-based assessments, identifies member needs and social determinants of health that may interfere with preventive or follow-up care, and facilitates care coordination. The advocate helps members navigate healthcare and social service systems, schedule appointments, understand care plans, and access benefits, entitlements, and community resources. The role also supports provider quality-improvement efforts, documents interactions and referrals, monitors outreach and care-gap closure metrics, and participates in seasonal campaigns and other quality initiatives. The position requires compliance with applicable regulations and organizational policies and includes other duties as assigned.

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 reside in Texas; the role supports Houston and surrounding areas.

Nice To Haves

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

Responsibilities

Conduct community outreach to identify members’ 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 access to preventive or follow-up care; facilitate care coordination.
Help members navigate healthcare and social service systems, schedule appointments, understand care plans, and access benefits or entitlements.
Collaborate with providers by sharing quality performance data, such as HEDIS and CAHPS, and supporting 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, 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.