Quality Care Member Advocate - Clinical

Centene
Dallas
Workplace: HybridFull timeUSD 27.02 - 48.55 hourlyFunction: Quality & Regulatory (Non-Software)Experience: 3+ yearsEducation: bachelorsSkills: ["Strong clinical documentation","Problem-solving","Communication","Attention to detail","Organization"]

Serve as a clinical member advocate focused on improving health outcomes by identifying and closing care gaps. Conduct community outreach and home visits to assess member needs, address social determinants of health, and help members navigate healthcare and social services. Coordinate with providers and internal teams using quality performance data (HEDIS, CAHPS), educate members on preventive and chronic care, document interactions, and maintain compliance with state and federal regulations.

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FursaFursa
Centene
Centene
3 days ago

Quality Care Member Advocate - Clinical

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Last checked: 4 hours agoStatus: Live

Job Summary

Serve as a clinical member advocate focused on improving health outcomes by identifying and closing care gaps. Conduct community outreach and home visits to assess member needs, address social determinants of health, and help members navigate healthcare and social services. Coordinate with providers and internal teams using quality performance data (HEDIS, CAHPS), educate members on preventive and chronic care, document interactions, and maintain compliance with state and federal regulations.
Location: Dallas
Workplace: Hybrid
Employment Type: Full time
Job Function: Quality & Regulatory (Non-Software)
Seniority: Mid level

Key Responsibilities

  • •Conduct outreach to members 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
  • •Help members navigate healthcare and social service systems, including scheduling appointments, understanding care plans, and accessing benefits/entitlements
  • •Collaborate with providers to share quality performance data (e.g., HEDIS, CAHPS) and support improvement initiatives
  • •Document member interactions, care gap closures, and referrals; monitor and report outreach effectiveness and care gap closure metrics

Pay and Benefits

Salary: USD 27.02 - 48.55 hourly
Perks:Health Insurance401kEquityLearning BudgetPaid LeaveRemote Work

Key Requirements

  • •Bachelor's Degree in Social Work, Public Health, Nursing, or related field; or equivalent experience required
  • •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 (e.g., diabetes, hypertension)
  • •Knowledge of Medicaid/Medicare programs and quality measures, including HEDIS
Experience:3+ yearsHealthcareCare coordinationCare managementMedicaidMedicareQuality measures
Education:Bachelor's in Social Work, Public Health, Nursing
Skills:Strong clinical documentationProblem-solvingCommunicationAttention to detailOrganization
Licenses:RNLCSW
Certifications:RN - Registered NurseLCSW - License Clinical Social Worker
Languages:EnglishSpanish

Company Brief

Centene
Centene Corporation is a diversified, multinational healthcare enterprise that provides government-sponsored and commercial healthcare programs and services, specializing in Medicaid, Medicare, and specialty benefits management across the United States.
Industry: Health Insurance (Payers)
Company Size: Enterprise (1,001+ employees)
Revenue: USD 1B+
Growth: Public Company
Valuation: Public Company (Market Cap in USD)
Funding: IPO / Publicly Listed
Headquarters: St. Louis, United States
Founded: 1984
WebsiteLinkedIn