Quality Care Member Advocate

Job Description

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.

Requirements

• Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future.
• Reside in Aroostook County or surrounding areas within the state of Maine.
• This is a hybrid role that requires travel.

Qualifications

• Bachelor's Degree in 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.

Skills

• LCSW - License Clinical Social Worker preferred.
• RN - Registered Nurse - State Licensure and/or Compact State Licensure preferred.

Benefits

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.