Senior Patient Advocate

1 day ago


Long Beach, California, United States Blue Shield of California Full time

Blue Shield of California is seeking a Senior Patient Advocate to join our team. As a Senior Patient Advocate, you will play a vital role in coordinating care for patients in an outpatient setting.

About the Role:

In this position, you will be responsible for ensuring adherence to standardized procedures while collaborating with healthcare providers. Your primary goal will be to design individualized care plans that promote quality patient outcomes and cost-effective health care services based on medical necessity.

Your Key Responsibilities:

  • Research and design treatment /care plans to promote quality of care and cost-effective health care services
  • Initiate timely individualized care plans based on health risk assessment completion and participation in interdisciplinary meetings
  • Determine appropriateness of referral for CM services, mental health, and social services
  • Provide referrals to Quality Management (QM), Disease Management (DM) and Appeals and Grievance department (AGD)
  • Conduct member care review with medical groups or individual providers for continuity of care, out of area/out of network and investigational/experimental cases
  • Manage member treatment to meet recommended length of stay and ensure DC planning at levels of care appropriate for the members needs and acuity

Requirements:

  • A current CA RN License
  • Certified Case Manager (CCM) Certification or in process of completing certification when eligible
  • At least 5 years of prior experience in nursing, healthcare or related field
  • A minimum of 3+ years managed care experience in inpatient, outpatient or managed care environment preferred

About the Salary:

The estimated salary range for this role is $87,230.00 to $130,900.00 per year, depending on location and experience.

Why Work for Blue Shield of California?

We offer a dynamic and supportive work environment where you can grow your career and make a real difference in the lives of our members. Our company values innovation, collaboration, and customer satisfaction. If you are passionate about delivering exceptional patient care and making a positive impact in the community, we encourage you to apply for this exciting opportunity.



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