Quality Care Member Advocate - Clinical

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 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. CST; 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 the Dallas Fort Worth, TX area. 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.
- Comply with all policies and standards
- Travel is required for member visits

Education/Experience: Bachelor's Degree Social Work, Public Health, Nursing, or related field; or equivalent experience required

Preferred Experience:
- 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, such as diabetes, hypertension, high cholesterol, or stress-related conditions.
- Knowledge of Medicaid/Medicare programs and quality measures, including HEDIS.
- Field-based experience strongly preferred; bilingual English/Spanish skills are a plus but not required.
- Strong clinical documentation, problem-solving, communication, attention to detail, organization, and time management skills required.
- Ability to adapt to changing business needs with openness, flexibility, and professionalism.
- Comfortable presenting findings clearly and concisely to various stakeholders.

Licenses/Certifications:
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RN - Registered Nurse - State Licensure and/or Compact State Licensure preferred, but not required

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LCSW - License Clinical Social Worker preferred, but not required

Pay Range: $27.02 - $48.55 per hour

At Centene, we connect people to the care they need to live healthier live