According to the Case Management Society of America, care management is a
collaborative process that assesses, plans, implements, coordinates,
monitors and evaluates options and services to meet an individual’s health
needs through communication and available resources to promote quality,
We attempt to assist in the efficient utilization of medical resources for
members with special health care needs, including highly complex chronic
and catastrophic cases to improve access to quality care and avoid
unnecessary medical costs.
Members who might benefit from these services are identified for care
management through utilization management activities, health risk
assessments and screening of administrative data.
Treating providers may refer members for care management services by
contacting the Medical Management Department at the numbers at the bottom
of this page. Members may also self-refer for care management.
There are currently Disease Management programs for asthma and diabetes.
Members receive education, coaching and other services to help them better
manage their condition. They also get action plans and have access to
disease management nurses.
Disease management nurses proactively perform or facilitate health risk
assessments and develop an action care plan based on the member’s
understanding of their condition, need for equipment and supplies, referral
for specialty care or other special considerations due to co-morbidities
including behavioral health and substance abuse.
To refer a patient for care or disease management, please call the Medical
Medicare Advantage: 1-844-282-3026
Health Insurance Exchange: 1-844-282-3025