Our care management team supports your efforts to provide quality, coordinated and integrated care to your patients — our members. The team includes nurses, care navigators, certified diabetes educators, and others, who can help members who have complex or chronic conditions that require coordination of services and periodic monitoring.
Care managers can:
- Assess members’ risk factors and needs
- Coordinate care by linking members to needed health practitioners and services
- Refer to community resources and/or behavioral health practitioners
- Help members overcome barriers to obtaining needed services or treatment compliance
Reasons you might refer a patient to care management:
- Non-compliance with treatment
- Consistently missed appointments for treatment or follow-up care
- Need for integrated behavioral health or personal care services
- High emergency department utilization rate
- Complex or chronic conditions that require integrated, coordinated care
How to refer a member to care management:
Simply call us at 1-800-829-0696.
Please note, when health care management decisions are made, they are based on the member’s benefit plan and the appropriateness of the proposed health care treatments, drugs and supplies for that member. We do not reward practitioners or other individuals conducting utilization review for issuing denials of coverage for health care treatments, drugs, and supplies. We offer no incentives to promote decision making that would result in inappropriate denials of services that would result in underutilization. We also do not use employee incentives or disincentives to encourage barriers to care and service.
