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Quality Care Advocate
Centene Corporation. Serve as a vital link between members and the healthcare system, focusing on improving health outcomes by identifying and closing care gaps .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in community health outreach, care coordination, and navigating healthcare systems to improve member health outcomes. Proficient in documenting care interactions and collaborating with healthcare providers while maintaining compliance with regulations.
Highest-signal resume keywords
Community Health OutreachCare CoordinationHEDIS FamiliarityLicensed Clinical Social Worker (LCSW)Registered Nurse (RN) Licensure
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Care Gap IdentificationCommunity-Based AssessmentsPreventive Care EducationChronic Condition ManagementData DocumentationQuality Improvement InitiativesAppointment SchedulingSocial Determinants of Health EvaluationMetrics MonitoringRegulatory Compliance
Soft Skills
Strong Communication SkillsInterpersonal SkillsRelationship BuildingCollaborationProblem-Solving
Certifications & Qualifications
Licensed Clinical Social Worker (LCSW)Registered Nurse (RN) Licensure
Industry Keywords
MedicaidMedicareHealthcare QualityCare ManagementHEDISCAHPSCommunity ResourcesHealth OutcomesSocial ServicesTexas Residency
About the role
Key responsibilities & impact- Serve as a vital link between members and the healthcare system, focusing on improving health outcomes by identifying and closing care gaps
- 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
- Facilitate care coordination
- Help members navigate complex healthcare and social service systems
- Assist with scheduling appointments, understanding care plans, and accessing benefits or entitlements
- Collaborate with providers to share quality performance data, including HEDIS and 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 appropriate systems
- Partner with Quality, Care Management, Provider Relations, and other internal departments
- 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
- Build relationships with local organizations and stakeholders as a community ambassador
- Perform other duties as assigned
- Comply with all policies and standards
Requirements
What you’ll need- Must reside in the state of Texas
- 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
- LCSW - Licensed Clinical Social Worker preferred
- RN - Registered Nurse - State Licensure and/or Compact State Licensure preferred
Benefits
Comp & perks- Health insurance
- 401K
- Stock purchase plans
- Tuition reimbursement
- Paid time off plus holidays
- Flexible approach to work with remote, hybrid, field or office work schedules