Quality Care Member Advocate at Centene

Ideal for a candidate with a Bachelor's Degree in Social Work, Public Health, or Nursing, or equivalent experience, and at least two years in community health o

Work type: remote

Location: Remote-NY

Salary: $27 – $49/hr

Type: Full-time

Summary

Ideal for a candidate with a Bachelor's Degree in Social Work, Public Health, or Nursing, or equivalent experience, and at least two years in community health or healthcare quality. **What makes it worth a look...** Centene offers a hybrid role with a pay range of $27.02 to $48.55 per hour, requiring local travel within specific New York regions including Central NY, Finger Lakes, Hudson Valley, Long Island, or New York City, with flexibility in work schedules. **You might be a good fit if you...** * Have experience working with health plan members and navigating community resources. * Are familiar with Medicaid/Medicare programs and quality measures like HEDIS. * Possess a strong understanding of social determinants of health.

Job Description

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPTThis is a hybrid role that requires local travel.Qualified candidates must reside in one of the following areas within the state of New York: Central NY Region, Finger Lakes Region, Hudson Valley Region, Long Island or New York CityPosition 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.

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.

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