Provider Management

Provider Management

Care Management

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, cost-effective outcomes.

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.

Disease 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.

Contact Information

To refer a patient for care or disease management, please call the Medical Management Department:

Medicaid: 1-877-428-3057
CHIP: 1-800-359-5613
USFHP: 1-800-678-7347
Medicare Advantage: 1-844-282-3100
Health Insurance Exchange: 1-844-282-3100