Everyone benefits when members receive necessary care and services in a timely manner. Throughout the case management process, nurse Care Managers work closely with patients, family members and physicians to gather information and develop a plan of care that everyone agrees with. Care Managers also work with patients to identify and coordinate care and services to minimize the risk of complications.
Patients and their families appreciate the assistance of a Care Manager to help them figure out the complicated health care system, and help them obtain the information needed to make informed health care decisions. Care Managers remain objective and will not interfere with any treatment decisions, since those remain between the patient and doctor. Involvement by a Care Manager will not have an negative effect on available benefits. In fact, when appropriate, the Care Manager will propose recommendations for services that are not covered, or locate alternative sources of funding when there is a need or service that is not covered.
All Health Plans members with serious, acute, or chronic illness or injury are eligible to receive case management services. Care Managers, in collaboration with you and your providers, will assess the current treatment plan and identify short and long term health care needs to ensure appropriate, cost-effective care throughout the health care continuum. Case management goals are focused on achieving an optimal level of wellness, autonomy, and function through advocacy and education. The Care Manager acts as resource by maintaining direct communication with you, your family, service providers, and health care team, while identifying and coordinating care and services, and evaluating the effectiveness of implemented plans.
Examples of case management services
- Ensure members receive necessary and appropriate health care services in a timely manner
- Assist members to achieve an optimal level of wellness and function
- Educate members and providers regarding insurance benefits, community resources, and alternative treatment and service options
- Develop a team approach between members and health care providers while planning, coordinating, monitoring, and evaluating an implemented care plan
If you would like more information about case management, contact a Care Management Services Department representative toll-free at 866-325-1550 or through our website using the following link: