Quality Care Member Advocate

📋 Description

• • As a Quality Care Member Advocate at Centene Corporation, you will play a pivotal role in transforming the health of our communities by serving as a crucial link between our 28 million members and the complex healthcare system. This position is designed for an individual passionate about improving health outcomes, identifying and closing care gaps, and empowering members to access the care they need.
• • Your primary responsibility will involve conducting proactive outreach within the community to identify members who have gaps in their care. This includes engaging with members to understand their unique circumstances and connecting them with appropriate healthcare services, preventive screenings, and vital resources. You will be instrumental in ensuring members receive timely and necessary medical attention.
• • A significant aspect of this role includes performing home visits or community-based assessments. These assessments are designed to gain a comprehensive understanding of a member's needs, including identifying social determinants of health (SDOH) that might act as barriers to accessing care. By understanding these barriers, you will be able to facilitate care coordination and connect members with relevant support systems.
• • You will act as a dedicated member advocate, guiding individuals through the often-intricate healthcare and social service landscapes. This involves assisting members with scheduling appointments, clarifying their care plans, understanding their benefits, and accessing entitlements. Your efforts will directly contribute to ensuring members receive the support required to close care gaps and maintain continuity of care, leading to better health outcomes.
• • Collaboration is key in this role. You will work closely with healthcare providers to share valuable quality performance data, such as HEDIS and CAHPS metrics, and actively support initiatives aimed at improving these quality measures. This partnership ensures a coordinated approach to member care.
• • Educating members is a core function. You will inform them about the importance of preventive care, strategies for managing chronic conditions effectively, and the availability of local community resources that can support their health and well-being.
• • Meticulous documentation is essential. You will be responsible for accurately recording all member interactions, tracking care gap closures, and managing referrals within the designated systems, ensuring data integrity and efficient workflow.
• • You will forge strong partnerships with various internal Centene departments, including Quality, Care Management, and Provider Relations. This cross-functional collaboration ensures that all efforts are aligned towards the common goal of improving member outcomes.
• • You will monitor and report on the effectiveness of outreach activities and the success rates of care gap closures, providing insights that can inform future strategies and interventions.
• • Maintaining strict compliance with all state and federal regulations, as well as organizational policies and standards, is paramount to this role.
• • You will participate in seasonal campaigns and targeted quality initiatives designed to enhance member engagement and drive measurable improvements in health outcomes.
• • Serving as a community ambassador, you will build and nurture relationships with local organizations, community leaders, and other stakeholders, fostering a network of support for Centene members.
• • This role offers a unique opportunity to make a tangible difference in the lives of individuals and communities, contributing to Centene's mission of transforming health, one person at a time.
• • Performs other duties as assigned, demonstrating flexibility and a commitment to the team's success.
• • Complies with all policies and standards, upholding the integrity and operational excellence of Centene Corporation.