Quality Care Member Advocate - Clinical

Job description

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. Physical Work Location: must be based in the Dallas Fort Worth, TX area NOTE: This is a Hybrid position - 50% Work from home and 50% IN Person Member Engagement via home visits. Mileage reimbursement is provided for travel in the community for member visits. Monday - Friday: 8:00 am - 5:00 pm (CST) 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. 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. Education/Experience: Bachelor's Degree Social Work, Public Health, Nursing, or related field; or equivalent experience required Strongly Preferred Experience: 3+ years of direct experience in care coordination, care management, community/public health education, HEDIS, quality measures, or health screening assessments. 3+ years of experience supporting preventive care outreach and helping members navigate community resources. Experience supporting members with physical health conditions, preventive care needs, and chronic disease management, such as diabetes, hypertension, high cholesterol, or stress-related conditions. Knowledge of Medicaid/Medicare programs and quality measures, including HEDIS. Field-based experience strongly preferred; bilingual English/Spanish skills are a plus but not required. Strong clinical documentation, problem-solving, communication, attention to detail, organization, and time management skills required. Ability to adapt to changing business needs with openness, flexibility, and professionalism. Comfortable presenting findings clearly and concisely to various stakeholders. Licenses/Certifications: RN - Registered Nurse - State Licensure and/or Compact State Licensure preferred LCSW - License Clinical Social Worker preferred Pay Range: $27.02 - $48.55 per hour Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law , including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act