Member Care Navigator (Hybrid)

Centene Corporation; Pittsburgh (Allegheny County); Hybrid; USD 56,000 - 101,000; Full time

Benefits offered by this job

Health insurance

401K

Stock purchase plan

Tuition reimbursement

Paid time off plus holidays

Flexible work arrangements

Job summary

Centene Corporation is seeking a field-based member advocate in Allegheny County to improve health outcomes through outreach, education, and care coordination. The role combines remote work with in-person home visits, roughly 50% remote and 50% field time, with a standard 8–5 schedule and flexible visits to meet member needs.

You will engage with members, schedule appointments, and connect them to services while collaborating with providers and internal teams.

Qualifications

• Bachelor's degree in Social Work, Public Health, or Nursing or equivalent experience.
• 2+ years in community health or healthcare quality.
• Experience with health plan members and navigating community resources.
• Familiarity with Medicaid/Medicare programs and quality measures (e.g., HEDIS).
• Strong communication and interpersonal skills.

Responsibilities

• Conduct outreach to members in the community to identify care gaps and connect them with services.
• Perform home visits or community assessments to evaluate needs and social determinants of health.
• Act as member advocate to help schedule appointments, explain care plans, and access benefits.
• Collaborate with providers to share quality data and support improvement initiatives.
• Educate members on preventive care, chronic condition management, and available resources.
• Document interactions, care gap closures, and referrals in the systems.
• Partner with Quality, Care Management and Provider Relations to improve outcomes.
• Monitor outreach effectiveness and care gap closure metrics.
• Maintain compliance with state and federal regulations and policies.
• Participate in seasonal campaigns and quality initiatives; build relationships with local organizations.
• Perform other duties as assigned and comply with policies.

Skills

Communication skills

Interpersonal skills

Community outreach

Care coordination

Education

Bachelor's degree in Social Work, Public Health, or Nursing

Job description

Centene Corporation is seeking a field-based member advocate in Allegheny County to improve health outcomes through outreach, education, and care coordination. The role combines remote work with in-person home visits, roughly 50% remote and 50% field time, with a standard 8–5 schedule and flexible visits to meet member needs.

You will engage with members, schedule appointments, and connect them to services while collaborating with providers and internal teams.