Quality Care Member Advocate

Centene Corporation; Philadelphia (Philadelphia County); Hybrid; USD 37,000 - 67,000; Full time

Benefits offered by this job

Health insurance

401K and stock plans

Tuition reimbursement

Paid time off plus holidays

Flexible work schedules (hybrid/remote

Job summary

Centene Corporation seeks a community-focused outreach specialist in Philadelphia County to educate members, identify care gaps, and coordinate care with providers and internal teams. Hybrid role combines remote and in-person home visits, with roughly 50% fieldwork and 50% office/remote activities.

The role emphasizes navigation of Medicaid/Medicare resources, scheduling support, and empowering members to access preventive and follow-up care while maintaining compliance with state and federal

Qualifications

• Bachelor’s degree in Social Work, Public Health, Nursing, or related field is required.
• 2+ years in community health or healthcare quality required.
• Experience working 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 to identify care gaps and connect them with appropriate services.
• Perform home visits or community-based assessments to evaluate member needs and social determinants of health.
• Assist with scheduling appointments, understanding care plans, and accessing benefits or entitlements.
• Collaborate with providers to share quality performance data and support improvement initiatives.
• Educate members on preventive care, chronic condition management, and available resources.
• Document member interactions, care gap closures, and referrals in the systems.
• Partner with internal departments to align efforts and improve member outcomes.
• Monitor outreach effectiveness and care gap closure metrics.
• Maintain compliance with state and federal regulations and organizational policies.
• Participate in seasonal campaigns and community engagement efforts.

Skills

Strong communication skills

Interpersonal skills

Community outreach

Documentation and reporting

Education

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

2+ years in community health or healthcare quality

Experience with health plan members and navigating resources

Familiarity with Medicaid / Medicare programs and quality measures

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.

Key Details

This hybrid position is designed to support meaningful member engagement through member education, community resources, and collaboration with providers to ensure members receive care and support. There is a balanced combination of remote work and in-person home visits, with approximately 50% of time dedicated to each. The standard schedule is Monday through Friday, 8:00 a.m. to 5:00 p.m; however, flexibility is a key requirement to effectively meet members’ needs, accommodate visit schedules, and ensure high-quality service delivery.

Service Delivery Area

Candidates must be based in Philadelphia County. Mileage reimbursement is provided for travel in the community for member visits.

• 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 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.

• competitive pay
• health insurance
• 401K and stock purchase plans
• tuition reimbursement
• paid time off plus holidays
• a flexible approach to work with remote, hybrid, field or office work schedules

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