Patient Care Coordinator

22 hours ago


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

Your Role

As a member of the Blue Shield of California Care Management team, you will play a crucial part in supporting the organization's mission to provide high-quality healthcare services.

The Nurse Consultant will report directly to the Manager of Care Management for the Population Health Management Medi-Cal Team. In this role, you will be responsible for ensuring that services are provided based on standardized procedures, including coordination of care with specialists and community resources.

Your Work

In this position, you will:

  • Develop and implement individualized care plans to promote quality care and cost-effective health services, adhering to medical necessity and contract requirements.
  • Initiate timely care plans based on assessments and facilitate transitions of care across all age groups.
  • Determine the appropriateness of referrals for CM services, mental health, and social services.
  • Provide referrals to Quality Management, Disease Management, and Appeals and Grievance departments.
  • Conduct care reviews with medical groups or individual providers to ensure continuity of care, address out-of-area/out-of-network cases, and investigate experimental/experimental cases.
  • Assess members' health behaviors, cultural influences, and client belief/value systems, evaluating information related to current/proposed treatment plans and identifying potential barriers.
  • Research opportunities for improvement in assessment methodology and actively promote continuous improvement.

We offer a competitive salary range of $**80,000 - $120,000** per year, depending on experience, location, and qualifications.



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