Quality Care Member Advocate

Centene Corporation

5d•$27 - $49

About The Position

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT Highly preferred that candidate resides in the state of Mississippi in either Forrest, Hinds, Bolivar, Lauderdale or surrounding areas. Role will require local travel. Position Purpose: 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.

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.