Our case management program is dedicated to delivering a personalized model that focuses on each member holistically. This model provides members with the greatest unmet health care needs with a single care manager to support their medical and behavioral health. Our care managers are an extension of the member's provider team and support each member in meeting their health care goals. Case management is one of our core clinical services. It is fully integrated within our robust suite of programs committed to the triple aim of improving the member experience, improving member health, and lowering health care costs.
Case management goals include:
- Advocating for members and their support systems
- Improving care through close collaboration with providers
- Assisting members as they navigate the health care system
- Educating members about their care options, benefits and coverage
- Ensuring full compliance with national quality standards, including those established by NCQA
- Supporting members with information to make educated decision regarding their health care
- Improving members' clinical, functional, emotional and psychosocial status by supporting their health and wellness needs, as well as their independence
Case managers are experienced registered nurses and social workers. They work with members and their providers to support the physician's treatment plan with development of a care plan based on the patient's needs, social support system, benefits and physician input.
Members experience highly personalized services because we integrate personal preferences, benefits and high-quality contracted providers to achieve optimum long-term outcomes both medically and financially.
Case managers work closely with disease managers and behavioral health clinicians to meet the needs of participants with chronic illness or coexisting conditions, such as chemical dependency and depression.
A case manager's role includes:
- Coordinating care and removing barriers to care
- Contributing to the member's safety and quality of life
- Achieving maximum value for the member's medical benefits
- Developing care plans based on the member's unique situation
- Acting as member advocate by providing expert advice and navigation
- Monitoring and assuring delivery of timely, medically appropriate and effective interventions