Quality Care Member Advocate

Centene Corporation; Evanston (IL); On-site; USD 37,000 - 67,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off and holidays

Flexible work schedules (remote,Hybrid

Job summary

Centene Corporation seeks a field-focused health outreach specialist to identify and close care gaps for members in the Cook County area. You will conduct home visits, coordinate with providers, and connect members with services to improve health outcomes.

The role emphasizes collaboration with internal teams, education on preventive care, and navigating Medicaid/Medicare resources while complying with regulations and policies.

Qualifications

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

Responsibilities

• Conduct outreach to members to identify care gaps and connect with services.
• Perform home visits or community assessments to evaluate member needs.
• Assist with scheduling appointments, understanding care plans, and accessing benefits.
• Collaborate with providers to share quality performance data and support improvement.
• Educate members on preventive care and resources.
• Document interactions, care gap closures, and referrals in the systems.
• Partner with internal departments to align efforts.
• Monitor outreach effectiveness and care gap closure metrics.
• Maintain compliance with state and federal regulations and policies.
• Participate in seasonal campaigns and quality initiatives to improve engagement and outcomes.
• Serve as a community ambassador with local organizations.
• Performs other duties as assigned.
• Complies with all policies and standards.

Skills

Communication

Interpersonal skills

Education

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

Job description

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.

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.

Key Details:

Must reside in our near Cook County, IL for member home visits. Travel up to 50%.

• 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

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

Licenses/Certifications

LCSW- License Clinical Social Worker preferred

RN - Registered Nurse - State Licensure and/or Compact State Licensure preferredPay Range: $27.02 - $48.55 per hour

At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day.

You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.

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