Quality Care Member Advocate

Centene Corporation

. Conduct outreach to members in the community to identify care gaps and connect them with appropriate healthcare services and resources .

Posted 10/30/2026full-timePittsburgh • Pennsylvania • United StatesJuniorMid-Level💰 $27 - $49 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in community health outreach, care coordination, and navigating healthcare systems, with a strong focus on member engagement and quality improvement initiatives. Proficient in documenting care interactions and maintaining compliance with healthcare regulations.

Highest-signal resume keywords

Community Health OutreachCare CoordinationHEDIS FamiliaritySocial Determinants Of HealthMedicaid / Medicare Knowledge

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Community-Based AssessmentsPreventive Care EducationChronic Condition ManagementCare Gap Closure DocumentationQuality Performance Data Sharing

Soft Skills

Strong Communication SkillsInterpersonal SkillsRelationship Building

Certifications & Qualifications

LCSWRN State Licensure

Industry Keywords

Healthcare ServicesSocial ServicesQuality Improvement InitiativesComplianceCare Plans

About the role

Key responsibilities & impact

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 and help members access preventive or follow-up care
Help members navigate 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 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

Requirements

What you’ll need

Bachelor's Degree in 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
Candidates must be based in or near Allegheny County
LCSW — Licensed Clinical Social Worker preferred
RN — Registered Nurse — State Licensure and/or Compact State Licensure preferred
Flexibility to accommodate member visit schedules and service needs

Benefits

Comp & perks

Competitive pay
Health insurance
401K plan
Stock purchase plans
Tuition reimbursement
Paid time off plus holidays
Flexible approach to work with remote, hybrid, field or office work schedules
Additional forms of incentives may be included in total compensation