Case Management is a program that assists members with complex medical or psychosocial situations or multiple chronic conditions. Our goal is to ensure continuity of care, reduce the chance of further complications, and facilitate efficient and appropriate delivery of care and services.

These services are provided by case managers who are Registered Nurses certified in case management and qualified Licensed Social Workers. Services include but are not limited to:

• Monitoring and evaluating the services and resources necessary to respond to a high risk individual’s health care needs

• Providing patient, family and home assessments

• Planning, implementing and coordinating treatment plans

• Disease education

We strive to promote a high level of member and provider satisfaction. General Case Management and Disease Specific Case Management programs are available. Examples of general case management diagnoses and/or conditions where we frequently assist include oncology patients, pediatric catastrophic patients, and those with heart failure or high risk diabetes. Currently, three diseases are managed through the Disease Specific Case Management programs. These include Sickle Cell Disease, HIV/AIDS and Behavioral Health.