With the changes in managed care, new jobs have opened up for nurses who seek patient interface outside the hospital setting.

Carla Trantham, RN, supervises the three health advocate units for Blue Cross Blue Shield of Georgia. She was one of two health advocates originally hired by the company in early 2003 and was promoted to supervisor in October 2003.

"When I first graduated from nursing school, I thought I wanted to stay in a hospital setting," Trantham said. "I wanted more hands-on nursing. However, as hospitals changed and caseloads increased, I moved to the insurance side, working with utilization reviews and then medical case management."

As a health advocate nurse, Trantham works directly with patients to manage their health care issues. For example, when surgery is needed for a patient, she talks with the physician's office and handles precertification for the procedure. Then she does preadmission counseling with the patient.

"Even though the physician discusses every aspect of the procedure with the patient, I'll do a preadmission call to ensure that the patient understands exactly what to expect," she said. "It helps to go over everything with them when they're at home and aren't distracted. We really educate them about their procedure and answer any questions. We serve as a bridge between the patient and the provider." Trantham stays involved with the patient after surgery. "We do postadmission counseling and continue to stay in touch with the patient during follow-up and beyond."

Once a health advocate nurse is assigned to a patient, the two maintain an ongoing relationship. "Usually, one nurse will work with the entire family, so there's a longterm relationship," Trantham said. "We do everything for them and their family, from helping expedite doctors' appointments to following up to make sure they're taking their medications properly. We become like members of their family." Health advocate nurses are registered nurses who work for managed-care organizations. Their services are generally paid for by client companies as part of their employee benefits package. The average salary is approximately $50,000.

Trantham said that case management and utilization review experience is helpful for health advocate nurses. Additionally, they should have excellent computer skills because the job requires knowledge of five to 10 different documentation programs. Home health experience is a plus.

"Every day is different," she said. "The biggest reward is working so closely with patients. This is an opportunity to help influence people's health throughout the continuum of their health issues. It's a very pro-active approach to health care. It's the best job I've ever had."