Case Management - Members

The Case Management Program is a service offered to all health plan members.  It addresses both short and long term issues for members and their families who are facing a serious illness or an acute event and could benefit from assistance in navigating complex systems of medical care.  Case Management frequently assists members with, but not limited to, the complex issues listed below:

  • Transplants
  • Cancer
  • Multiple hospital admissions
  • Severe burns
  • Major or multiple organ system failure
  • Complicated wound care
  • Head or spine injuries
  • Falls
  • Trauma or major health issues
  • Medical/surgical cases with complications
  • Complicated health care issues or hospital discharge planning
  • Obstetrics
  • Understanding your doctors instructions and avoiding Emergency Room visits

Participation in Case Management is voluntary and does not alter your benefits.  You may choose whether you wish to be enrolled in Case Management. Additionally, you can discontinue participation in the program at any time.

Case Managers work closely with you, your family, and your providers in the development of a mutually agreed upon Care Plan. Case Managers will monitor and assist you in reaching the goals and outcomes established in the Care Plan. They are in ongoing communication with your Primary Care Provider.

Our goal is to assist you in managing your health needs and prevent further complications.  Follow your doctor’s advice.  It is important to your health. If you need help with it, call a Case Manager.  They are available Monday through Friday, 8:00am – 4:30pm EST toll free at 1-888-211-9913.

Last Updated: 10/01/2017