Medical Management

Our care management department provides support to members based on each individual’s risks and unmet needs. These care needs are assessed by licensed nurses, social workers and counselors, as well as non-clinical professionals. We use a bio-psycho-social model (BPS) to help us identify what care our members need. Then, the integrated case manager performs a health risk assessment to determine the member’s medical, behavioral health and bio-psychosocial status.

Care managers work with the member, member’s family, PCP, psychiatrist, substance abuse counselor or any other healthcare team member to achieve a quality-focused, cost-effective care plan. Care management educates members on their specific disease and how to prevent worsening of their illness or any complications. The goal is to maintain or improve their health status.

Care management programs include, but are not limited to:

  • Pregnancy outreach and high-risk OB
  • Special health care needs
  • Behavioral health/substance abuse

You may have concerns about one of your patients. We can help coordinate many needed services. Just call 1-855-772-9076 and ask for the care management department.

Our disease management programs help members manage specific conditions. We assist with regular communications, targeted outreach and support, and focused education.

The conditions in our program include diabetes, asthma, heart failure, sickle cell anemia, hepatitis C, obesity and HIV/AIDS.

To learn more, just call 1-855-772-9076 and ask for the care management department. You can refer your patients to our disease management programs anytime.